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Journal of Clinical and Experimental Neuropsychology Publication details, including instructions for authors and subscription information: http://www.tandfonline.com/loi/ncen19
Truth in labeling: Are we really an international society? Charles G. Matthews
a
a
Department of Neurology , University of Wisconsin Medical School , Madison Published online: 04 Jan 2008.
To cite this article: Charles G. Matthews (1992) Truth in labeling: Are we really an international society?, Journal of Clinical and Experimental Neuropsychology, 14:3, 418-426, DOI: 10.1080/01688639208407617 To link to this article: http://dx.doi.org/10.1080/01688639208407617
PLEASE SCROLL DOWN FOR ARTICLE Taylor & Francis makes every effort to ensure the accuracy of all the information (the “Content”) contained in the publications on our platform. However, Taylor & Francis, our agents, and our licensors make no representations or warranties whatsoever as to the accuracy, completeness, or suitability for any purpose of the Content. Any opinions and views expressed in this publication are the opinions and views of the authors, and are not the views of or endorsed by Taylor & Francis. The accuracy of the Content should not be relied upon and should be independently verified with primary sources of information. Taylor and Francis shall not be liable for any losses, actions, claims, proceedings, demands, costs, expenses, damages, and other liabilities whatsoever or howsoever caused arising directly or indirectly in connection with, in relation to or arising out of the use of the Content. This article may be used for research, teaching, and private study purposes. Any substantial or systematic reproduction, redistribution, reselling, loan, sublicensing, systematic supply, or distribution in any form to anyone is expressly forbidden. Terms & Conditions of access and use can be found at http:// www.tandfonline.com/page/terms-and-conditions
Journal of Clinicaland Expuimental Nerrmpsychology 1992, Vol. 14, No.3, pp. 418-426
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PRESIDENTIAL ADDRESS S A N DIEGO
Truth in Labeling: Are We Really an International Society?*
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Charles G. Matthews Department of Neurology University of Wisconsin Medical School, Madison
I have long suspected that everyone in our profession has buried deep within their filing cabinet an undelivered speech, a speech which, as the American poet Thomas Merton said in a very different context, lies “sealed in the night of contemplation, sitting in the dark, waiting to be born.” I have such a speech, and you will be spared hearing most of it only because I shared some of its main themes with thoughtful others who managed to head me off at the pass (and you should all be very grateful to them). I made the mistake of saying what I thought might really be interesting would be some kind of dazzling synthesis of ecology and theology, topped off with a fast solution to the science/religion dichotomy, the mindbody problem, and as time permitted, the true nature of humankind. Reactions to this modest proposal ranged from rapid eye glazing and REM sleep to some frankly brutal observations that past efforts along these lines have had a tendency to yield very bad philosophy, much worse science, and God knows (and I use His/Her name advisedly) what kind of theology. Undeterred by this negative feedback and by arch comments from certain critics within my own family who pointed out what they felt was my fundamental failure to appreciate the differences between grand and grandiose, not to mention cosmic and comic, I continued to pursue these mega-themes for a very long time. I did so under a provisional speech title “Kirkegaardian Categories and the Category Test: Do We Have a Measurement Problem Here?”. Luckily for you, during these months I was laboring on what I was stubbornlyconvincedwould be a magnum opus, I found myself heavily engaged in a lot of the day-to-day practical problems and stresses facing our Society, especially in its efforts to be or to become truly international in its scope and impact, and I reluctantly concluded that the times and the occasion demanded a somewhat more focused and concrete presentation. During this year as President, a number of criticisms of the Society and its Governing Board have come to my attention. I believe many of them have been
* Address for correspondence: Charles G. Matthews, Ph.D., Department of Neurology,
University of Wisconsin Medical School, 600 North Highland Avenue, Madison, WI 53792, USA.
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shrill and intemperate but nonetheless understandable because they have been based upon serious misperceptions about our true numbers and our geographic distribution, as well as upon inaccurate estimates andlor wishful thinking regarding the financial resources of the Society which purportedly are not only substantial but which may have been squandered in high living rather than being properly used to alleviate the neuropsychological needs of the Third World. Let’s begin with some membership figures. Of our 3,000 members, over 2,300 are from the United States, 240 from Canada and 335 from Western European countries. At our summer meeting in Queensland, our European Secretary, Lh. Harry Van Der Vlugt, pointed out that of the 335 European members, the majority come from Scandinavian countries, the Netherlands, Belgium, and England. Other European countries, despite large numbers of psychologists in their national interdisciplinary neuroscience societies, are very poorly represented on our membership roster. These include Germany with 19 members, Italy and Spain with 15 each, and France with only 14. When one considers the large membership of the various National Neuroscience Societies from which INS could reasonably attract members (e.g., a Dutch society of over 700, a German society of some 900, and a French society of 6001,our drawing power has been modest indeed. Why this is so is not entirely clear, but some of it has to do with the very uneven level of development of neuropsychology in these countries and also with a great deal of residual nationalism and historical rivalry between and among various European societies, and this suggests that the emerging European Common Market still has some distance to go with respect to a common currency for neuropsychological scientific and professional interchange. It is difficult to comment on INS problems and prospects in countries behind what used to be called the Iron Curtain because of the massive political-swial changes still going on in that part of the world. Our total 1992 membership from all of these countries, including Russia, numbers only 14. If our European membership census figures are discouraging (and let me assure you we would not have 50% of those current 335 members were it not for Dr. Van Der Vlugt’s heroic efforts as European Secretary over the past many years), an overview of the state of INS relationships with neuropsychologists in Central and South America reveals an even bleaker landscape. As with Europe, the problem is not one of lack of interest in neuropsychology or lack of substantial numbers of neuropsychologists and neuropsychological educational and research programs underway. Alfredo Ardila in a 1990 article in The Clinical Neuropsychologist presents a very impressive summary of these activities and historical developments in a paper titled “Neuropsychology in Latin America”, and I commend it to you for your thoughtful re-review. Ardila presents a country-by-country sketch of the way in which national neuropsychology societies have been created in Argentina, Chile, Colombia, Honduras, Mexico, Nicaragua, Peru, and Uruguay in the years following the 1 lth annual meeting of the INS held in Mexico City in 1983, With reference to this 1983 meeting, Ardila says: “Latin American representatives
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proposed to the INS the creation of a Latin American branch of the Society. This, however, did not happen: the major obstacle was that, while other regional branches, the European one in particular, were entirely self-supporting and functioning within the by-laws and dues structure of the INS, Latin American economic and scientific heterogeneity resulted in difficulties in reaching agreement on uniform requirements. These issues are being reconsidered by INS as the organization grows into the 1990’s”. Near the end of his article, Ardila makes another observation which merits direct quotation. He says: “Scientific research in so-called Third World countries should emphasize ingenuity and creativity instead of material resources and technological sophistications. Hence, neuropsychology, whose methodology often requires little in the way of costly equipment, represents a field where workers in those countries have realistic potential for state-of-the-art contributions”. Dr. Ardila’s comments parallel and reinforce in a number of respects some observations made in a recent overview of neuropsychological activities in Central America which has been prepared by Dr. Ted Judd (personal communication, 1991), based on his many years of professional contacts with persons in those countries. Dr. Judd reports that the Central American nations have many things in common. Neuropsychological activities are mostly confined to the Capital City in each of the countries. Interest is mostly among clinical psychologists, but includes some neurologists, psychiatrists, and speech pathologists. Most of the activity is clinical, with research less well developed. There are few university courses in neuropsychology and as yet no formal training programs. All of the nations face problems of very limited funding and resources for neuropsychological work, as well as limited availability of tests and limited appropriate norms.Most have significant indigenous populations of people whose languages and cultures present a further challenge to providing neuropsychological services. Judd’s country-by-country synopsis describes small groups of neurologists and psychologists in Guatemala and El Salvador (N = 12 each), a Honduran Neuropsychology Society of 85 which publishes a journal now in its fourth year, a Nicaraguan Neuropsychology Society of some 30 members, and a well-developed community of neuropsychologists in Mexico with university programs, active research, a long history, and many clinicians throughout the country. These national groups have organized into a Federation for Neuropsychology in Central America and into the Latin American Neuropsychological Society, the latter group inaugurated in 1989 in Buenos Aires and already consisting of several hundred individual members plus the National Neuropsychology groups of Argentina, Chile, Colombia, Honduras, Mexico, Nicaragua, and Peru. Despite all the evident interest and organizational vitality in Central and South America I have just reported, current INS membership in all of Latin America totals only 18 individuals. The same thinness in our ranks obtains with respect to the Pacific Rim countries where membership is largely represented by 76 people from Australia and New Zealand, plus 18 Japanese, 3 from India, and 1each from Taiwan and the Philippines.
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Among mid-eastern countries, Israel provides the clear majority with 10 members. If the total INS membership for the entire continent of Africa would care to get together for lunch, immediate seating away from the kitchen should certainly be available for an intimate party of 3. Based on my review of the correspondence files I inherited from our past President, Dr. Brooks, the attitudes of most members of the Society toward the Board of Governors and its policies seem to fall somewhere between massive indifference and benign neglect. There is, however, a subset of members from Third World countries, and members who feel they are representing those interests, who are very unhappy with us. The list of grievances is a long one, but much of the litany can be captured in two major themes: one is a broad accusation of Western cultural/scientific arrogance emanating from North AmencadEuropean domination of the Society, replete with outdated assumptions that what is good for General Motors must still be good for the rest of the world. The second main theme predictably has to do with money and with the unwise distribution of the Society’s presumably vast fiscal resources in favor of the status quo and its affluent, largely white Western membership. Each of these themes deserves separate lengthy discussion, and there is no way 1 can do justice to either of them today. Perhaps I can capture for you part of the outrage directed towards the first of these issues by sharing some extended quotes from a letter I recently received from one of our most articulate and clearly one of our most disaffected members. He says: “The point I have been trying to make is that American neuropsychology is even more arrogant than American psychology in general in making the assumption that nothing of any great import happens outside the U.S.A. and perhaps Canada. As a result, a very limited kind of neuropsychology, appropriate for only a fraction of the world’s population, is presented to the rest of the world as if there could be no other kind of neuropsychology, and as if the education and the cultural assumptions on which American neuropsychology is based were obviously universals that applied everywhere in the world. This is pernicious, and in-so-far as INS is party to the myth, I can’t see that it is entitled to use the term “international” in more than a purely decorative sense.” The letter continues: “What I call in my book the “Great Western Homogenizer” applies to the people of North America (excluding of course the poor cousins down south in Mexico), to Western Europe (which at a push might be extended as far east as Moscow), the United Kingdom, and some parts of the population of Australia and New Zealand. Of course, this is a fair chunk of the world, but Western neuropsychological performance models and the norms these models expect are frequently invalid even within these countries. A neuropsychologist I met in New York (in the Bronx, I think) talked about neuropsychological testing
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* The author is very grateful to Victor Nell, D. Litt et Phil., Associate Professor, Director, Health Psychology Unit, University of South Africa, Pretoria, for his substantial contribution to this address.
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in a thermometer factory, and he said it was like a United Nations, with Sikhs in turbans, Puerto Ricans, Mexicans, Pakistanis, and a large number of other nonhomogenized persons present. The U.S. has huge minority populations who are done a disservice by easy assumptions of universalism. These comments apply with equal force to Canada and Australia, and less obviously to the Common Market countries in which there is a very large “guest labor” force. “As an old seminarian, you will recall the great medieval debate between nominalists and realists (he flatters me - actually I didn’t have a clue), which in the course of time has become a debate between materialists and idealists. Neuropsychology, unfortunately, has fallen into the hands of the latter, who are doing their discipline a great disservice because Halstead’s ridiculous assumption that there is such a thing as “biological intelligence” continues, as a kind of subterranean crypto-psychology to guide many of the assumptions of mainstream neuropsychology. The sad thing about the universalist model (people are people are people) is that inferior performances are always attributed to inferiority rather than to cultural differences. So the benevolent universalists end up making frankly ethnocentric statements to explain their findings.” The rest of his comments actually fit better with a later section of my talk today, namely some of the recommendations that have been made for our Society to become at long last truly international, but my correspondent has a full head of steam going at this point in his letter, and I am fearful of interrupting him, even at this distance, so let me continue. He says: “Leaving aside these heady matters of dogma and ideology, the issue boils down to a much more simple one about norms that can safely be used in settings of cultural diversity. This is a project to which INS might like to turn its attention, and in so doing rescue itself from its irrelevance to most of the world’s population. What else might INS do in order to make its use of the word international more meaningful? I think some affirmative action needs to be built into the INS constitution, making it mandatory for a significant number of neuropsychologists working in the developing countries to be included in your governance structure, both for the association and for the journal. It would also be neat if INS were to define a number of key issues relating to the development of neuropsychology in non-Western settings, and if it used its organizational muscle in order to speed up such developments. Some areas that are likely to be especially important are neurobehavioral screening of workers in the chemical industry and agriculture for early toxic effects, early detection of the aids dementia complex, and the reliable quantification of brain damage sustained in motor vehicle accidents so that victims get a reasonable compensation, based not just on the visible injuries, but also on changes in intellect and behavior. Unfortunately, until very recently (in our country) and to the present in many other settings, these poor people, mostly black, get compensation only for their broken bones.” Certain sections of this letter might be challenged or rejected as rhetorical excess in the service of an extreme political-philosophical position, but I think that kind of response is at once too facile and too evasive. If one is tempted to
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believe that this ‘first general thesis of Western scientific-cultural domination can, in fact, be so easily dismissed, let me remind you that we have all read a paper in Bruin ulldLanguuge (1990)titled “Crossed Aphasia in Chinese: a Clinical Survey”. The authors are three Chinese neurologists who, based on extensive studies of stroke patients, conclude that (to quote from their abstract) “the language function of the Han (the largest ethnic group in China) is not localized in the left brain but in the right or both hemispheres. There is no definite Wernicke’s area in the left brain of the Chinese people and the neuro pathway of the language function in the brain of the Chinese people is not similar to people who speak phonetic languages. Consequently, the universal applicability of the (Western) theories of contralaterality of the language function in the dominant hemisphere established by Dax and Broca are questioned.” Census figures are hard to come by, but it is probably worth noting that the Han Chinese number some eight hundred million people, and they are still counting. The second main source of annoyance with the Society and its Board has to do with money and our perceived miserly response to requests from Third World and Eastern European neuropsychologists for financial assistance of one kind or another, including consideration of reduced journal and membership fees and providing travel stipends for INS members who cannot afford to attend our meetings. Some of you may recall that in 1985, the INS Board inaugurated a travel fund entry on the annual dues statement for volunteer contributions earmarked for this purpose. Over a period of 6 years, the grand total of $547.00 poured into our coffers. While this sum was appreciated and is certainly a tribute to those who gave, it was hardly a basis for organizing charter flights to INS meetings from around the world. I now confess, and cheerfully so, that without any request for formal Board action or approval, I took it upon myself to authorize our Treasurer to blow the whole bundle on a plane ticket and modest hotel room for one member from one of our most impoverished Third World countries to attend the recent Australia meeting. I did so because the $547.00 was sitting there in a sort of reproachful lump and not doing anything, so I used it. If my action offends anyone’s bookkeeping or other sensibilities, feel free to impeach me. If nothing else, an impeachment motion tomorrow afternoonwould liven up our stereotypically dull business meeting and should contribute to the Society’s general morale and sense of high purpose. Why have these repeated requests for charitable contributions from our members yielded so modest a response? I can only speculate, but I think it has some of its genesis in our personal attitudes towards poverty, and how these attitudes are inevitably colored by strong feelings of resentment, both in the targeted giver and in the potential recipient. We end up in an uneasy and acrimonious debate that might be titled “Biting The Hand That Does Not Feed Us”. I believe a number of misperceptions are operating on both sides of this kind of nonexchange. One is grounded in skepticism over assertions that organizations
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involved in Third World efforts do not and will not have a political social agenda, and that disclaimer has indeed been made. This is a position which strikes me as at worst disingenuous and at best naively innocent. Innocence, political or otherwise, has its charms, but it also has a darker and less adaptive side; Graham Greene reminds us in his book The Quiet American: “Innocence is like a leper who has lost his bell, wandering the world, meaning no harm.’’ I believe a corollary mistake is to expect that financial and organizational support for Third World development will flow naturally from a generalized disposition to do the right thing. The problem with that expectancy is that we are not dealing here with the easy endorsementof Yuppie eco-chic issues which are currently in vogue. Examples might include saving the Brazilian rain forest or listening, over white wine and Brie, to Joseph Campbell and Bill Moyers on PBS talking earnestly about trying on a variety of religious belief systems, like computer software packages, to determine personal goodness of fit. What we are really talking about (or failing to talk about) are deeply felt concerns that are much less fashionable and much more demanding and troubling. They would include, certainly in Latin America, the impact of liberation theology and preferential options towards the paor, and the price paid for such acted-on beliefs by six dead Jesuits and their housekeeper in El Salvador. Everybody loves the rain forest, but not everyone likes Jesuits, and so our diffusely, other-directed impulses to do good fall into discord and disarray when they must be operationalized within the context of repressive national governments or other social-political realities which are distasteful or alien to us. I believe the charge to our Society and its Board should therefore be to identify, organize, and prioritize the various Third World proposals and initiatives that have been and will be offered, to judge their relative merits, and to do in a way which as much as possible avoids getting bogged down in an endless quagmire of organizational infighting and bureaucratic squabbling over distinctions and definitions about the deserving and the undeserving poor. Until the membership is offered a coherent, well-reasoned plan for action, the Society will continue to be immobilized in the matrix of diffuse, other-directed impulses to do good I mentioned a moment ago. Another line of resistance to greater involvement by our Society in Third World affairs is to wrap ourselves in the mantle of pure science and by so doing to disengage ourselves from the unwashed masses surrounding the Ivory Tower. This defensive position can be made especially attractive to psychologists by offering a lofty reminder that once there lived a man named Abraham Maslow who wrote elegantly and persuasively about needs hierarchies, The theme can be developed in a number of different ways, but the bottom line is the scriptural injunction that, while people may not live by bread alone, bread is a lot more basic in the needs hierarchy than are finger tappers, and to think or act otherwise is self-serving and delusional in the extreme. Finally, at least for purposes of today’s restricted format, a strong case can be made for asserting that requests for redistribution and expansion of the financial
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resources of the INS could not be timed more poorly. The affluent West is faced with widespread recession, structural unemployment, urban anarchy and despair, and vast unmet health care and social support needs. If one would care to put a more parochial point to the problem, many members of our Society work in proprietary rehabilitation hospital settings, and, at least in the United States, are watching the growing numbers of proprietary psychiatric hospitals that are going out of business, and wondering whether a moral might be lurking there for our own future employment security. My comments thus far may strike you as unreasonably dysphoric, if not clinically depressed. However, my intention has been in the service of reality testing and to offer a partial data base from which you must each make your own carefully nuanced judgment as to whether the objections and barriers I have raised represent legitimate concerns 01 whether they are nothing more than rationalizations for not mounting more effective and widespread educational and scientific programs in neuropsychology as rapidly as some of our members obviously would prefer. Any disposition one might have toward depression evaporates when one reviews the extraordinary acts of individual charity shown by members of the Society as witnessed by the w m hospitality shown to foreign, specifically Russian, attendees at our Orlando and San Antonio meetings. Following initial hosting and travel arrangements by our colleagues in the New York neuropsychology group, our Florida and Texas members took these visitors into their homes. They fed them and entertained them with a generosity few of us would extend to our blood relatives, much less to our in-laws. If the Society through its Board can figure out ways to harness and direct that kind of good will through sustained programmatic efforts, it would be neurotic and unworthy to be too gloomy about our international future. There is no question that we have a mandate for action. It can be found in the by-laws of the International Neuropsychology Society, Inc. Article I, Section IV of the bylaws is titled “Purpose”, and it simply and clearly states the following: “The purposes of the corporation are as set forth in the Articles of Organization; namely (and please note the sequence and priority here) for charitable, educational, scientific and literary purposes, and in furtherance thereof, to promote research, service and education in neuropsychology.” The Society and its Board have not been entirely unresponsive to this mandate. The decision to hold the 1983 meeting in Mexico City was driven largely by these concerns, as were the repeated requests for our members to contribute to the travel fund I alluded to earlier. In early 1990, the Board approved and provided start-up funding for an INS Liaison Committee which was given the charge by past President Neal Brooks to “formulate and develop policies and systems by which INS can more effectively collaborate with colleagues around the world, particularly those who may have financial and/or political difficulties in communicating outside their country”. I am delighted to inform you that the Liaison Committee is now chaired by Dr. Manfred Meier who is a past INS President and
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who, as many of you know, has a well documented record of service in international programs, particularly as directed toward Latin America. Dr. Meier has arranged for the Liaison Committee to meet at this conference, and I have asked him to report on the deliberations of his Committee and their preliminary recommendations and ideas at our business meeting tomorrow afternoon. Some years ago I listened to a presentation at APA by Bruce Sales. Most of his talk has faded from my not very good memory, but I vividly recall that in his discussion of future planning and challenges for the audience, he said “we live with our yes’s.” My first reaction to this was one of annoyance and quick dismissal because obviously we also live with our no’s, but when one thinks this through, there is a critical qualitative difference. The yes’s tend to nourish and encourage new and forward looking attitudes and programs, but the no’s do not. So let us think about INS and what we are now and what we can and should become, and act upon our yes’s, because to live only with our no’s will make us narcissistic and self-absorbed and we will behave badly. The INS Board will respond to the mandate you give it, and the Society will, in the end, be no more and no less international than you, its members, truly want it to be. A couple of years ago I ended a talk with the following words, and with minor changes they may serve once again. I said “My hour has now fled along with much of the audience. I will, therefore, conclude with conventional but heartfelt best wishes, and a touch of envy, for all of you who will be left to wrestle for the next thirty years or so with some of the problems and challenges that I have so roughly tried to sketch out for you. Thank you very much for granting me the honor of serving as President of the International Neuropsychology Society during the past year, and for your courteous attention to my remarks this afternoon.”
REFERENCES Ardila, A. (1990). Neuropsychology in Latin America. The Clinical Neuropsychologisr, 4 , 121-132. Yu-Hum, H., Ying-Guan,Q. & Gui-Qing,Z.(1990). Crossed aphasia in Chinese: A clinical survey. Brain and Language, 39,347-356.
Journal of Clinical and Experimental Neuropsychology Publication details, including instructions for authors and subscription information: http://www.tandfonline.com/loi/ncen19
Truth in labeling: Are we really an international society? Charles G. Matthews
a
a
Department of Neurology , University of Wisconsin Medical School , Madison Published online: 04 Jan 2008.
To cite this article: Charles G. Matthews (1992) Truth in labeling: Are we really an international society?, Journal of Clinical and Experimental Neuropsychology, 14:3, 418-426, DOI: 10.1080/01688639208407617 To link to this article: http://dx.doi.org/10.1080/01688639208407617
PLEASE SCROLL DOWN FOR ARTICLE Taylor & Francis makes every effort to ensure the accuracy of all the information (the “Content”) contained in the publications on our platform. However, Taylor & Francis, our agents, and our licensors make no representations or warranties whatsoever as to the accuracy, completeness, or suitability for any purpose of the Content. Any opinions and views expressed in this publication are the opinions and views of the authors, and are not the views of or endorsed by Taylor & Francis. The accuracy of the Content should not be relied upon and should be independently verified with primary sources of information. Taylor and Francis shall not be liable for any losses, actions, claims, proceedings, demands, costs, expenses, damages, and other liabilities whatsoever or howsoever caused arising directly or indirectly in connection with, in relation to or arising out of the use of the Content. This article may be used for research, teaching, and private study purposes. Any substantial or systematic reproduction, redistribution, reselling, loan, sublicensing, systematic supply, or distribution in any form to anyone is expressly forbidden. Terms & Conditions of access and use can be found at http:// www.tandfonline.com/page/terms-and-conditions
Journal of Clinicaland Expuimental Nerrmpsychology 1992, Vol. 14, No.3, pp. 418-426
01684634~140344183.00 Q swds 8 Zeitlillgex
PRESIDENTIAL ADDRESS S A N DIEGO
Truth in Labeling: Are We Really an International Society?*
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Charles G. Matthews Department of Neurology University of Wisconsin Medical School, Madison
I have long suspected that everyone in our profession has buried deep within their filing cabinet an undelivered speech, a speech which, as the American poet Thomas Merton said in a very different context, lies “sealed in the night of contemplation, sitting in the dark, waiting to be born.” I have such a speech, and you will be spared hearing most of it only because I shared some of its main themes with thoughtful others who managed to head me off at the pass (and you should all be very grateful to them). I made the mistake of saying what I thought might really be interesting would be some kind of dazzling synthesis of ecology and theology, topped off with a fast solution to the science/religion dichotomy, the mindbody problem, and as time permitted, the true nature of humankind. Reactions to this modest proposal ranged from rapid eye glazing and REM sleep to some frankly brutal observations that past efforts along these lines have had a tendency to yield very bad philosophy, much worse science, and God knows (and I use His/Her name advisedly) what kind of theology. Undeterred by this negative feedback and by arch comments from certain critics within my own family who pointed out what they felt was my fundamental failure to appreciate the differences between grand and grandiose, not to mention cosmic and comic, I continued to pursue these mega-themes for a very long time. I did so under a provisional speech title “Kirkegaardian Categories and the Category Test: Do We Have a Measurement Problem Here?”. Luckily for you, during these months I was laboring on what I was stubbornlyconvincedwould be a magnum opus, I found myself heavily engaged in a lot of the day-to-day practical problems and stresses facing our Society, especially in its efforts to be or to become truly international in its scope and impact, and I reluctantly concluded that the times and the occasion demanded a somewhat more focused and concrete presentation. During this year as President, a number of criticisms of the Society and its Governing Board have come to my attention. I believe many of them have been
* Address for correspondence: Charles G. Matthews, Ph.D., Department of Neurology,
University of Wisconsin Medical School, 600 North Highland Avenue, Madison, WI 53792, USA.
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shrill and intemperate but nonetheless understandable because they have been based upon serious misperceptions about our true numbers and our geographic distribution, as well as upon inaccurate estimates andlor wishful thinking regarding the financial resources of the Society which purportedly are not only substantial but which may have been squandered in high living rather than being properly used to alleviate the neuropsychological needs of the Third World. Let’s begin with some membership figures. Of our 3,000 members, over 2,300 are from the United States, 240 from Canada and 335 from Western European countries. At our summer meeting in Queensland, our European Secretary, Lh. Harry Van Der Vlugt, pointed out that of the 335 European members, the majority come from Scandinavian countries, the Netherlands, Belgium, and England. Other European countries, despite large numbers of psychologists in their national interdisciplinary neuroscience societies, are very poorly represented on our membership roster. These include Germany with 19 members, Italy and Spain with 15 each, and France with only 14. When one considers the large membership of the various National Neuroscience Societies from which INS could reasonably attract members (e.g., a Dutch society of over 700, a German society of some 900, and a French society of 6001,our drawing power has been modest indeed. Why this is so is not entirely clear, but some of it has to do with the very uneven level of development of neuropsychology in these countries and also with a great deal of residual nationalism and historical rivalry between and among various European societies, and this suggests that the emerging European Common Market still has some distance to go with respect to a common currency for neuropsychological scientific and professional interchange. It is difficult to comment on INS problems and prospects in countries behind what used to be called the Iron Curtain because of the massive political-swial changes still going on in that part of the world. Our total 1992 membership from all of these countries, including Russia, numbers only 14. If our European membership census figures are discouraging (and let me assure you we would not have 50% of those current 335 members were it not for Dr. Van Der Vlugt’s heroic efforts as European Secretary over the past many years), an overview of the state of INS relationships with neuropsychologists in Central and South America reveals an even bleaker landscape. As with Europe, the problem is not one of lack of interest in neuropsychology or lack of substantial numbers of neuropsychologists and neuropsychological educational and research programs underway. Alfredo Ardila in a 1990 article in The Clinical Neuropsychologist presents a very impressive summary of these activities and historical developments in a paper titled “Neuropsychology in Latin America”, and I commend it to you for your thoughtful re-review. Ardila presents a country-by-country sketch of the way in which national neuropsychology societies have been created in Argentina, Chile, Colombia, Honduras, Mexico, Nicaragua, Peru, and Uruguay in the years following the 1 lth annual meeting of the INS held in Mexico City in 1983, With reference to this 1983 meeting, Ardila says: “Latin American representatives
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proposed to the INS the creation of a Latin American branch of the Society. This, however, did not happen: the major obstacle was that, while other regional branches, the European one in particular, were entirely self-supporting and functioning within the by-laws and dues structure of the INS, Latin American economic and scientific heterogeneity resulted in difficulties in reaching agreement on uniform requirements. These issues are being reconsidered by INS as the organization grows into the 1990’s”. Near the end of his article, Ardila makes another observation which merits direct quotation. He says: “Scientific research in so-called Third World countries should emphasize ingenuity and creativity instead of material resources and technological sophistications. Hence, neuropsychology, whose methodology often requires little in the way of costly equipment, represents a field where workers in those countries have realistic potential for state-of-the-art contributions”. Dr. Ardila’s comments parallel and reinforce in a number of respects some observations made in a recent overview of neuropsychological activities in Central America which has been prepared by Dr. Ted Judd (personal communication, 1991), based on his many years of professional contacts with persons in those countries. Dr. Judd reports that the Central American nations have many things in common. Neuropsychological activities are mostly confined to the Capital City in each of the countries. Interest is mostly among clinical psychologists, but includes some neurologists, psychiatrists, and speech pathologists. Most of the activity is clinical, with research less well developed. There are few university courses in neuropsychology and as yet no formal training programs. All of the nations face problems of very limited funding and resources for neuropsychological work, as well as limited availability of tests and limited appropriate norms.Most have significant indigenous populations of people whose languages and cultures present a further challenge to providing neuropsychological services. Judd’s country-by-country synopsis describes small groups of neurologists and psychologists in Guatemala and El Salvador (N = 12 each), a Honduran Neuropsychology Society of 85 which publishes a journal now in its fourth year, a Nicaraguan Neuropsychology Society of some 30 members, and a well-developed community of neuropsychologists in Mexico with university programs, active research, a long history, and many clinicians throughout the country. These national groups have organized into a Federation for Neuropsychology in Central America and into the Latin American Neuropsychological Society, the latter group inaugurated in 1989 in Buenos Aires and already consisting of several hundred individual members plus the National Neuropsychology groups of Argentina, Chile, Colombia, Honduras, Mexico, Nicaragua, and Peru. Despite all the evident interest and organizational vitality in Central and South America I have just reported, current INS membership in all of Latin America totals only 18 individuals. The same thinness in our ranks obtains with respect to the Pacific Rim countries where membership is largely represented by 76 people from Australia and New Zealand, plus 18 Japanese, 3 from India, and 1each from Taiwan and the Philippines.
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Among mid-eastern countries, Israel provides the clear majority with 10 members. If the total INS membership for the entire continent of Africa would care to get together for lunch, immediate seating away from the kitchen should certainly be available for an intimate party of 3. Based on my review of the correspondence files I inherited from our past President, Dr. Brooks, the attitudes of most members of the Society toward the Board of Governors and its policies seem to fall somewhere between massive indifference and benign neglect. There is, however, a subset of members from Third World countries, and members who feel they are representing those interests, who are very unhappy with us. The list of grievances is a long one, but much of the litany can be captured in two major themes: one is a broad accusation of Western cultural/scientific arrogance emanating from North AmencadEuropean domination of the Society, replete with outdated assumptions that what is good for General Motors must still be good for the rest of the world. The second main theme predictably has to do with money and with the unwise distribution of the Society’s presumably vast fiscal resources in favor of the status quo and its affluent, largely white Western membership. Each of these themes deserves separate lengthy discussion, and there is no way 1 can do justice to either of them today. Perhaps I can capture for you part of the outrage directed towards the first of these issues by sharing some extended quotes from a letter I recently received from one of our most articulate and clearly one of our most disaffected members. He says: “The point I have been trying to make is that American neuropsychology is even more arrogant than American psychology in general in making the assumption that nothing of any great import happens outside the U.S.A. and perhaps Canada. As a result, a very limited kind of neuropsychology, appropriate for only a fraction of the world’s population, is presented to the rest of the world as if there could be no other kind of neuropsychology, and as if the education and the cultural assumptions on which American neuropsychology is based were obviously universals that applied everywhere in the world. This is pernicious, and in-so-far as INS is party to the myth, I can’t see that it is entitled to use the term “international” in more than a purely decorative sense.” The letter continues: “What I call in my book the “Great Western Homogenizer” applies to the people of North America (excluding of course the poor cousins down south in Mexico), to Western Europe (which at a push might be extended as far east as Moscow), the United Kingdom, and some parts of the population of Australia and New Zealand. Of course, this is a fair chunk of the world, but Western neuropsychological performance models and the norms these models expect are frequently invalid even within these countries. A neuropsychologist I met in New York (in the Bronx, I think) talked about neuropsychological testing
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* The author is very grateful to Victor Nell, D. Litt et Phil., Associate Professor, Director, Health Psychology Unit, University of South Africa, Pretoria, for his substantial contribution to this address.
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in a thermometer factory, and he said it was like a United Nations, with Sikhs in turbans, Puerto Ricans, Mexicans, Pakistanis, and a large number of other nonhomogenized persons present. The U.S. has huge minority populations who are done a disservice by easy assumptions of universalism. These comments apply with equal force to Canada and Australia, and less obviously to the Common Market countries in which there is a very large “guest labor” force. “As an old seminarian, you will recall the great medieval debate between nominalists and realists (he flatters me - actually I didn’t have a clue), which in the course of time has become a debate between materialists and idealists. Neuropsychology, unfortunately, has fallen into the hands of the latter, who are doing their discipline a great disservice because Halstead’s ridiculous assumption that there is such a thing as “biological intelligence” continues, as a kind of subterranean crypto-psychology to guide many of the assumptions of mainstream neuropsychology. The sad thing about the universalist model (people are people are people) is that inferior performances are always attributed to inferiority rather than to cultural differences. So the benevolent universalists end up making frankly ethnocentric statements to explain their findings.” The rest of his comments actually fit better with a later section of my talk today, namely some of the recommendations that have been made for our Society to become at long last truly international, but my correspondent has a full head of steam going at this point in his letter, and I am fearful of interrupting him, even at this distance, so let me continue. He says: “Leaving aside these heady matters of dogma and ideology, the issue boils down to a much more simple one about norms that can safely be used in settings of cultural diversity. This is a project to which INS might like to turn its attention, and in so doing rescue itself from its irrelevance to most of the world’s population. What else might INS do in order to make its use of the word international more meaningful? I think some affirmative action needs to be built into the INS constitution, making it mandatory for a significant number of neuropsychologists working in the developing countries to be included in your governance structure, both for the association and for the journal. It would also be neat if INS were to define a number of key issues relating to the development of neuropsychology in non-Western settings, and if it used its organizational muscle in order to speed up such developments. Some areas that are likely to be especially important are neurobehavioral screening of workers in the chemical industry and agriculture for early toxic effects, early detection of the aids dementia complex, and the reliable quantification of brain damage sustained in motor vehicle accidents so that victims get a reasonable compensation, based not just on the visible injuries, but also on changes in intellect and behavior. Unfortunately, until very recently (in our country) and to the present in many other settings, these poor people, mostly black, get compensation only for their broken bones.” Certain sections of this letter might be challenged or rejected as rhetorical excess in the service of an extreme political-philosophical position, but I think that kind of response is at once too facile and too evasive. If one is tempted to
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believe that this ‘first general thesis of Western scientific-cultural domination can, in fact, be so easily dismissed, let me remind you that we have all read a paper in Bruin ulldLanguuge (1990)titled “Crossed Aphasia in Chinese: a Clinical Survey”. The authors are three Chinese neurologists who, based on extensive studies of stroke patients, conclude that (to quote from their abstract) “the language function of the Han (the largest ethnic group in China) is not localized in the left brain but in the right or both hemispheres. There is no definite Wernicke’s area in the left brain of the Chinese people and the neuro pathway of the language function in the brain of the Chinese people is not similar to people who speak phonetic languages. Consequently, the universal applicability of the (Western) theories of contralaterality of the language function in the dominant hemisphere established by Dax and Broca are questioned.” Census figures are hard to come by, but it is probably worth noting that the Han Chinese number some eight hundred million people, and they are still counting. The second main source of annoyance with the Society and its Board has to do with money and our perceived miserly response to requests from Third World and Eastern European neuropsychologists for financial assistance of one kind or another, including consideration of reduced journal and membership fees and providing travel stipends for INS members who cannot afford to attend our meetings. Some of you may recall that in 1985, the INS Board inaugurated a travel fund entry on the annual dues statement for volunteer contributions earmarked for this purpose. Over a period of 6 years, the grand total of $547.00 poured into our coffers. While this sum was appreciated and is certainly a tribute to those who gave, it was hardly a basis for organizing charter flights to INS meetings from around the world. I now confess, and cheerfully so, that without any request for formal Board action or approval, I took it upon myself to authorize our Treasurer to blow the whole bundle on a plane ticket and modest hotel room for one member from one of our most impoverished Third World countries to attend the recent Australia meeting. I did so because the $547.00 was sitting there in a sort of reproachful lump and not doing anything, so I used it. If my action offends anyone’s bookkeeping or other sensibilities, feel free to impeach me. If nothing else, an impeachment motion tomorrow afternoonwould liven up our stereotypically dull business meeting and should contribute to the Society’s general morale and sense of high purpose. Why have these repeated requests for charitable contributions from our members yielded so modest a response? I can only speculate, but I think it has some of its genesis in our personal attitudes towards poverty, and how these attitudes are inevitably colored by strong feelings of resentment, both in the targeted giver and in the potential recipient. We end up in an uneasy and acrimonious debate that might be titled “Biting The Hand That Does Not Feed Us”. I believe a number of misperceptions are operating on both sides of this kind of nonexchange. One is grounded in skepticism over assertions that organizations
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involved in Third World efforts do not and will not have a political social agenda, and that disclaimer has indeed been made. This is a position which strikes me as at worst disingenuous and at best naively innocent. Innocence, political or otherwise, has its charms, but it also has a darker and less adaptive side; Graham Greene reminds us in his book The Quiet American: “Innocence is like a leper who has lost his bell, wandering the world, meaning no harm.’’ I believe a corollary mistake is to expect that financial and organizational support for Third World development will flow naturally from a generalized disposition to do the right thing. The problem with that expectancy is that we are not dealing here with the easy endorsementof Yuppie eco-chic issues which are currently in vogue. Examples might include saving the Brazilian rain forest or listening, over white wine and Brie, to Joseph Campbell and Bill Moyers on PBS talking earnestly about trying on a variety of religious belief systems, like computer software packages, to determine personal goodness of fit. What we are really talking about (or failing to talk about) are deeply felt concerns that are much less fashionable and much more demanding and troubling. They would include, certainly in Latin America, the impact of liberation theology and preferential options towards the paor, and the price paid for such acted-on beliefs by six dead Jesuits and their housekeeper in El Salvador. Everybody loves the rain forest, but not everyone likes Jesuits, and so our diffusely, other-directed impulses to do good fall into discord and disarray when they must be operationalized within the context of repressive national governments or other social-political realities which are distasteful or alien to us. I believe the charge to our Society and its Board should therefore be to identify, organize, and prioritize the various Third World proposals and initiatives that have been and will be offered, to judge their relative merits, and to do in a way which as much as possible avoids getting bogged down in an endless quagmire of organizational infighting and bureaucratic squabbling over distinctions and definitions about the deserving and the undeserving poor. Until the membership is offered a coherent, well-reasoned plan for action, the Society will continue to be immobilized in the matrix of diffuse, other-directed impulses to do good I mentioned a moment ago. Another line of resistance to greater involvement by our Society in Third World affairs is to wrap ourselves in the mantle of pure science and by so doing to disengage ourselves from the unwashed masses surrounding the Ivory Tower. This defensive position can be made especially attractive to psychologists by offering a lofty reminder that once there lived a man named Abraham Maslow who wrote elegantly and persuasively about needs hierarchies, The theme can be developed in a number of different ways, but the bottom line is the scriptural injunction that, while people may not live by bread alone, bread is a lot more basic in the needs hierarchy than are finger tappers, and to think or act otherwise is self-serving and delusional in the extreme. Finally, at least for purposes of today’s restricted format, a strong case can be made for asserting that requests for redistribution and expansion of the financial
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resources of the INS could not be timed more poorly. The affluent West is faced with widespread recession, structural unemployment, urban anarchy and despair, and vast unmet health care and social support needs. If one would care to put a more parochial point to the problem, many members of our Society work in proprietary rehabilitation hospital settings, and, at least in the United States, are watching the growing numbers of proprietary psychiatric hospitals that are going out of business, and wondering whether a moral might be lurking there for our own future employment security. My comments thus far may strike you as unreasonably dysphoric, if not clinically depressed. However, my intention has been in the service of reality testing and to offer a partial data base from which you must each make your own carefully nuanced judgment as to whether the objections and barriers I have raised represent legitimate concerns 01 whether they are nothing more than rationalizations for not mounting more effective and widespread educational and scientific programs in neuropsychology as rapidly as some of our members obviously would prefer. Any disposition one might have toward depression evaporates when one reviews the extraordinary acts of individual charity shown by members of the Society as witnessed by the w m hospitality shown to foreign, specifically Russian, attendees at our Orlando and San Antonio meetings. Following initial hosting and travel arrangements by our colleagues in the New York neuropsychology group, our Florida and Texas members took these visitors into their homes. They fed them and entertained them with a generosity few of us would extend to our blood relatives, much less to our in-laws. If the Society through its Board can figure out ways to harness and direct that kind of good will through sustained programmatic efforts, it would be neurotic and unworthy to be too gloomy about our international future. There is no question that we have a mandate for action. It can be found in the by-laws of the International Neuropsychology Society, Inc. Article I, Section IV of the bylaws is titled “Purpose”, and it simply and clearly states the following: “The purposes of the corporation are as set forth in the Articles of Organization; namely (and please note the sequence and priority here) for charitable, educational, scientific and literary purposes, and in furtherance thereof, to promote research, service and education in neuropsychology.” The Society and its Board have not been entirely unresponsive to this mandate. The decision to hold the 1983 meeting in Mexico City was driven largely by these concerns, as were the repeated requests for our members to contribute to the travel fund I alluded to earlier. In early 1990, the Board approved and provided start-up funding for an INS Liaison Committee which was given the charge by past President Neal Brooks to “formulate and develop policies and systems by which INS can more effectively collaborate with colleagues around the world, particularly those who may have financial and/or political difficulties in communicating outside their country”. I am delighted to inform you that the Liaison Committee is now chaired by Dr. Manfred Meier who is a past INS President and
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who, as many of you know, has a well documented record of service in international programs, particularly as directed toward Latin America. Dr. Meier has arranged for the Liaison Committee to meet at this conference, and I have asked him to report on the deliberations of his Committee and their preliminary recommendations and ideas at our business meeting tomorrow afternoon. Some years ago I listened to a presentation at APA by Bruce Sales. Most of his talk has faded from my not very good memory, but I vividly recall that in his discussion of future planning and challenges for the audience, he said “we live with our yes’s.” My first reaction to this was one of annoyance and quick dismissal because obviously we also live with our no’s, but when one thinks this through, there is a critical qualitative difference. The yes’s tend to nourish and encourage new and forward looking attitudes and programs, but the no’s do not. So let us think about INS and what we are now and what we can and should become, and act upon our yes’s, because to live only with our no’s will make us narcissistic and self-absorbed and we will behave badly. The INS Board will respond to the mandate you give it, and the Society will, in the end, be no more and no less international than you, its members, truly want it to be. A couple of years ago I ended a talk with the following words, and with minor changes they may serve once again. I said “My hour has now fled along with much of the audience. I will, therefore, conclude with conventional but heartfelt best wishes, and a touch of envy, for all of you who will be left to wrestle for the next thirty years or so with some of the problems and challenges that I have so roughly tried to sketch out for you. Thank you very much for granting me the honor of serving as President of the International Neuropsychology Society during the past year, and for your courteous attention to my remarks this afternoon.”
REFERENCES Ardila, A. (1990). Neuropsychology in Latin America. The Clinical Neuropsychologisr, 4 , 121-132. Yu-Hum, H., Ying-Guan,Q. & Gui-Qing,Z.(1990). Crossed aphasia in Chinese: A clinical survey. Brain and Language, 39,347-356.
