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Journal of Clinical and Review article Article id: JCNN-20-09

Behavioural Neuroscience or : What’s in a Name? Call for a New Vocabulary in Psychology by PATISA PATISA: Psychological Association for Transformation and Innovation, South Africa Mureriwa JF1,5*, Mphuthi SF1, Katjene MM1, Modipa TSO1, Sibanda T3, Rapapali T2,5, Tau AP4, Moshanyana MP1 and Segabutle Y4 *1Clinical , Private Practice, Pretoria, South Africa 2Clinical Psychologist, Private Practice, Bloemfontein, South Africa 3Clinical Psychologist, Private Practice, Johannesburg, South Africa 4Educational Psychologist, Private Practice, Pretoria, South Africa 5Neuropsychologist, Private Practice, Pretoria, South Africa

*Corresponding author: Abstract

Dr. Mureriwa JF, Given the position articulated in this article, it is apparent that the need Neuropsychologist, Private to replace the word “psychology” as a label of the discipline with the Practice, Pretoria, South Africa more appropriate “behavioural neuroscience” is long overdue. Reading Louis Pasteur Medical Suites, through the argument herein, the conceptual and practical justification 380 Francis Baard Street, for the call for alignment of the vocabulary of the discipline with the Pretoria, South Africa, 0002, Tel: reality of the attendant professional reality becomes self-evident. 27-82-5747145, E-mail: [email protected] The word psychology originates from the ancient Greek word , which means or soul. Concepts of soul and mind are central in the Received: 08 September 2020 fields of philosophy and theology. The concept of mind, however, Accepted: 24 October 2020 continues to define psychology, a health profession, which specializes Published: 28 October 2020 in the scientific study of human and animal behaviour. This anomaly is attributable to the pervasive influence of the unproven and outdated Citation: -body dualism. This philosophy states that two Mureriwa JF, Mphuthi SF. substances comprise humans, a material body and an immaterial mind, Katjene MM, Modipa TSO, Sibanda T, et al. Behavioural which are exact opposites of each other. There are several philosophical Neuroscience or Psychology: positions which articulate how these two substances relate to each other. What’s in a Name? Call for a The most influential position appears to be that of Rene Descartes, New Vocabulary in Psychology by which states that the two substances can influence each other. In this PATISA. J Clin Neurol Neurosci paper, we call to the harm that accrues from continuing to use 2020;1:09 language and vocabulary, such as the word “psychology” itself, which suggest an acceptance of mind-body dualism. We argue that Copyright: transformation and innovation in psychology requires a complete break ©2020 Psychological Association from centuries-old misconceptions about the dualism between the mind for Transformation and and body. We propose a change of vocabulary, starting with the Innovation, SA. This article is an replacement of the name “psychology” with “behavioural open-access article distributed neuroscience”. The proposed new name emphasizes the reality that under the terms and conditions of what is currently termed psychology is a health profession, on par with, the Creative Commons and built upon, the same foundation as, other health professions. There Attribution (CC-BY) license is as much need to change the language associated with psychology as

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Journal of Clinical Neurology and Neuroscience Review article Article id: JCNN-20-09

there was a need in the past, to change the language that supported unacceptable social practices, such as racism and gender discrimination. The change in vocabulary will necessitate changes to the training of , which will broaden their scope of practice within the realm of health professions. As the scope of psychology broadens, the underserved populations in South Africa will gain better access to innovative psychological services in the spheres of health, education and industry.

Keywords: Behavioural neuroscience, Psychology, PATISA, Mind

Introduction Psychology as a Health Profession in the Light of Cartesian Dualism In South Africa, the Health Professions Act 56 of 1974(1), classifies psychology as one of the 12 health professional groups. The psychology profession currently comprises 6 types of practitioners, namely, clinical psychologists, educational psychologists, counselling psychologists, industrial psychologists, neuropsychologists, registered counsellors, and psychometrists. In this paper, we address the concern that the psychology profession’s contribution to health delivery in South Africa is severely constrained by the philosophy of mind-body dualism. We expect the constraints to be similar in other jurisdictions where the dualism has tended to guide the scope of the profession. Whilst we focus on South Africa as a case in point, the principles we assert are applicable internationally. For centuries, humans have believed in the existence of and souls. In the Western world, ancient Greeks referred to minds and souls as psyche, which is the root of the modern word “psychology” and “”. Christians adopted the early Greek ideas, and created the dogma that humans are composed of both physical bodies and immaterial immortal souls. Within the African context, in the mind-body dualism is apparent. Belief in immaterial souls is well established, as evidenced by strong beliefs in ancestral spirits, witchcraft, divination, rituals, and spiritual healing. Africans also believe in the power of physical interventions for illness, which are provided in the form of medications and surgical procedures. Given the pervasive existence of the mind-body dualism across time and diverse geographies, it may be considered inevitable that the contemporary discipline of psychology and its attendant professional groups are imbued with the philosophical position of dualism. It is of some value for purposes of moving forward to indicate briefly, the historical developments and their importance for health professions before examining contemporary implications of the mind-body dualism for psychology. In the 17th century, Rene Descartes (2), a French philosopher, proposed a version of dualism which is very influential to this day. This version is popularly known as “Cartesian dualism”. Descartes claimed that the mind and the body are distinct and separate, but they interact with each other. Descartes proposed that the mind exerts its influence on the body within the pineal gland of the . Gendle (3), citing Mehta (4), noted the following: Cartesian dualism helped to wrestle medicine from the oversight of the church. Prior to Cartesian dualism, diseases were attributed to nonmaterial forces such as personal/collective wrongdoing. It was also believed that for the soul to ascend to heaven, the human body had to be preserved intact (5). As a result, there was a religious prohibition on the study of human through dissection. Descartes, through mind-body dualism, demythologised the body and handed over its study to medicine. Thus, the way was paved for progress in medical science through the study of and anatomy. At the same time, by isolating mind and body, dualism denied its significance in individuals' of health.

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Journal of Clinical Neurology and Neuroscience Review article Article id: JCNN-20-09

Despite medicine’s focus on physical assessment and treatment, it did not abandon mind-body dualism. This is evidenced by the fact that one of medicine’s specialist disciplines, psychiatry, focusses on the treatment of diseases of the “mind”, using medicines and . The difference between psychiatrists and psychologists is that whilst psychologists are, supposedly, restricted to dealing only with the mind, psychiatrists are free to deal with both the mind and the body. (6), a physician and neurophysiologist, is considered the founder of psychology. He established the first psychology laboratory in the department of philosophy at the University of Leipzig, Germany. His first experiment used reaction time measures to assess the speed of (7). One of Wundt’s greatest achievements is that he established psychology as a scientific discipline separate from philosophy and from biology. His separation of psychology from biology suggests, however, that Wundt accepted mind-body dualism (6).

Contemporary Evidence of Dualistic Thought Referrals by physicians to psychologists are often based on a clear separation between the body and the mind. Some of the referrals take the following format: “Dear colleague (psychologist). Kindly see this patient. There is nothing physically wrong with him. The problem appears to be merely psychological.” The influence of mind-body dualism can be illustrated by this real-life incident below: Anecdote 1: One of the authors, a clinical psychologist, phoned a psychiatric ward to arrange an admission for a patient. The phone was answered by a nurse who confirmed that beds were available, and then the following discussion followed:

Nurse: “So, you will be providing for this patient”? Psychologist: “Yes” Nurse: “Who will be providing treatment?” Psychologist: “The psychiatrist, Dr…”

Comment: The word “treatment” and “therapy” mean exactly the same thing, i.e. treatment. Attributing treatment to psychiatry and therapy to psychology shows how we bend over backwards to be in line with mind-body dualism. The so-called “therapy” is no less a form of treatment than medication. Indeed, psychotherapy is as much a biological treatment as medication (8).

Several more expressions by health practitioners, psychologists, and the general public alike, reveal the continuing pervasive influence of Cartesian dualism despite lack of evidence for the soundness of this philosophy. Many of the words and expressions are double-barrel words, with one part referring to physical, and the other referring to mind (mental). Examples include the following (in alphabetical order):

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Journal of Clinical Neurology and Neuroscience Review article Article id: JCNN-20-09

 Biological psychology.  Bio-psycho-social model.  Medical and psychological.  Mind over matter.

 Mind-body medicine.  Neuropsychology.  Patient (for psychiatrist) vs client (for psychologist).  Physical and mental illness.  Physical and emotional stress.  Physical and mental torture.  Psychiatric and psychological disorders (Same disorders).  .  Psychosomatic.  Treatment (by psychiatrist) vs therapy (by psychologist).  And many others.

The dualistic concepts have also found their way into legal systems: The Health Professions Act of South Africa (1) defines a health practice partly as physical and mental examination of persons; and the diagnosis, treatment or prevention of physical or mental defects, illnesses or deficiencies in humankind. In similar fashion, in 1948 the World Health Organization (WHO) (9) defined health as a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity. The label “psychology” and related concepts continue to be used in the 21st century, despite the absence of evidence that they reflect the realities of the world in any meaningful way. The persistence of mind-body dualism is similar to the persistence of misconceptions, myths, prejudices, and superstitions which humans have entertained over centuries. Calls by some members of society to abandon misconceptions or to stop unfair practices often meet with stiff resistance. As a consequence, in the past, important changes were only brought about by activism or other forms of struggle. It is striking, for example, that even though the reality is that human populations are made up of males and females, the word “he” was used to cover both males and females in some circumstances. It took activism to introduce the expression “he or she”, instead of simply “he”. At a superficial level, this change in vocabulary might now appear to be common-, the change contributed to creating awareness of the acceptance of systemic gender discrimination. The language of dualism is so firmly entrenched in our everyday language that even the authors of this article find themselves inadvertently using the terms which we are trying to remove from the current vocabulary. It requires deliberate, sustained effort to effect the changes we propose; the argument presented here will require that the name of the association that the authors represent in future be changed to align with the neuro-behavioural science professions. This can be achieved in the long run. An example of successful deliberate change of vocabulary for ideological is the substitution of the labels, teachers and students to educators and learners, which was implemented by the post-apartheid government in South Africa, after 1994. ©CIENCIA SCIENTIFIC PUBLISHER PVT.LTD

Journal of Clinical Neurology and Neuroscience Review article Article id: JCNN-20-09

Response to Dualism Burden of Proof Regarding the Reality of Souls and Minds Proponents of the philosophies of dualism claim that minds and souls exist and are the subject matter of psychology. In practice, psychologists no longer refer to souls, but they continue to accept the existence of minds. Our primary response to mind-body dualism is that this philosophy is not a fact but just a claim, for which the proponents should provide evidence. In the absence of evidence, the rational position for psychologists is to be skeptical that minds exist. Given this skepticism, it is not rational for “psychologists” to continue to call themselves by a name which declares that minds exist. Instead of attempting to disprove mind-body dualism, we focus instead, on showing that psychological processes can be accounted for by biological factors.

The Neurobiology of Behaviour In addition to responding to mind-body dualism with skepticism, it is important to show that the behaviours, which we currently refer to as “psychology” can be explained without recourse to the idea of mind or soul. Behaviours are electro-chemical events, involving, as they do, , brain structures and brain networks, as well as measurable electrical activity (EEG). This is irrespective of the setting in which the behaviours are taking place; it could be in a environment (educational), the workplace (industrial) or a health facility (clinical). Table 1 represent a list of basic psychological processes with an overview of the neurobiological factors.

Table 1: Overview of the Neurobiology of Basic Psychological Processes This Table is adapted from Mureriwa 2017b (10)]: Process Some Aspect of Neurobiology mechanisms include histamine (HA), serotonin (5HT), noradrenaline Arousal (NA), acetylcholine (ACH), glutamate (GLU), dopamine (DA), and hypocretin/orexin (HCT) as neurotransmitters acting within the basal forebrain, hypothalamus, and brain stem (11). The cortex of each part of the brain plays an important role in the production of consciousness, especially the prefrontal and posterior occipital cortices and the claustrum (12) Sense organs have receptors which capture energy from the environment and Sensation transmit it, via the peripheral , to the . The thalamus transmits the sensory information to the appropriate cortical areas, such as the occipital lobe (for vision). There are several brain networks for attention. Example: Dorsal attention Attention networks include structures in the parietal, occipital, and frontal lobes and anterior cingulate bilaterally. The neurotransmitters involved are acetylcholine, dopamine and norepinephrine.

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Journal of Clinical Neurology and Neuroscience Review article Article id: JCNN-20-09 is the interpretation of sensation. It involves the secondary and tertiary cortical areas of the occipital, parietal, and temporal areas. The Perception perception also involves limbic ( and ) as well as frontal structures. Learning relies on widespread brain networks. Learning brings about changes at the synapse. (13), who was awarded a Nobel Prize for his Learning & Memory work, showed that learning, as a process in psychotherapy, leads to an increase in the number and size of synapses.

Emotion Limbic structures, e.g. amygdala, septal nucleus. Limbic structures, such as cingulate gyrus and para-hippocampus. Widely distributed networks. The posterior association areas of the brain, (Thinking) where parietal, occipital, and temporal lobes overlap, are important in abstract thinking. There are reciprocal with the frontal lobes.

An exhaustive recounting of the evidence for the role of the nervous system in the production and control of behaviour is beyond the scope of this paper. A Google search at the US National Library of Medicine will review many peer-reviewed journal articles which provide evidence regarding the neurobiology of behaviour such as the paper by Jiang et al. (14), and Eichenbaum (15). The techniques for investigating the links between the nervous system and behaviour are well established medical science tools. They include the neuro-imaging modes of functional MRI, magneto- encephalography, haemoencephalography, routine clinical EEG, quantitative EEG, and others. Furthermore, the findings from the neuro-imaging studies are then evaluated against the measurements from psychological tests, such as tests of attention, memory, and executive function. Based on the findings of neuro-imaging studies, backed up by psychological tests, there is clear evidence that structures of the brain, and the functional connections between those structures, account for the behaviours which we call psychological. Investigations of the neurobiology of behaviour have also focused on the biological impact of psychotherapy. Mureriwa 2017a (8) proposed that the why different types of psychotherapy are equally effective is that they have a final common pathway, the autonomic nervous system. Unsurprisingly, many of the psychiatric medications work by modulating the autonomic nervous system. This means, in other words, that psychotherapy and medication both involve biological mechanisms of action, which are not necessarily identical, but overlap. They may, for example, both lead to reduction of adrenergic activity, which leads to calmness and relaxation. President George W. Bush declared the decade of the brain (https://www.loc.gov/loc/brain/proclaim.html) in 1990. This included a 4 billion-dollar grant to support research projects in the fields of psychology and neuroscience as referenced by Cody & George (16) and Leefman & Hildt (17) amongst others. From such studies, there is ample information about the networks involved in different behaviours and pathological conditions. We give two examples.  Anxiety network: Superior parietal lobule, medial superior frontal gyrus, insula, middle temporal gyrus, and amygdala.

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Journal of Clinical Neurology and Neuroscience Review article Article id: JCNN-20-09

 Depressed mood: Medial superior frontal gyrus, orbitofrontal cortex, insula, posterior cingulate, anterior cingulate, inferior frontal gyrus pars opercularis (Broca’s Area). Inferior frontal gyrus pars triangularis, orbital part of inferior frontal gyrus, habenula, and amygdala

The reasons why behaviour should be considered a product of the body rather than the hypothetical mind can be summarized in a short paragraph: All behaviours, including perception, emotions, and , have their origin in the . In other words, all the phenomena, which we refer to as psychological, owe their existence to physical structures including the eyes, ears, skin, nose, tongue, and multiple other senses8. They are electro-chemical events. The organization of behavioural processes, as is the case for all other body processes, such as walking, is a function of the brain. This is clearly evidenced by the fact that when the brain is damaged or disrupted, the individual’s capacities and are dramatically altered. Medications, and all the therapeutic interventions which return the brain to optimal function, restore the individual’s behaviour to normality. “Normal” capacity and functioning restored in this fashion can then take place in all settings (workplace, learning environment, social environment, and so forth).

The South African Context as an Example of the Perpetuation of Cartesian Dualism

We have indicated above the impact of the mind-body dualism and the need for change of vocabulary as an integral part of aligning the profession with the reality of health professions. We have indicated that South Africa is a case in point, whilst recognizing that the principles and assertions made are applicable to other jurisdictions across the globe. The Health Professions Council of South Africa (HPCSA) groups the health practitioners under 12 Professional Boards. Within each professional board, there is a hierarchy of seniority based on level of training. For the purposes of this paper only, we allocated abbreviations for each of these boards, as shown in Appendix A.

The Features which Health Practitioners Share in Common The Health Professions Act (Section 17) specified that the practice of a health profession includes the following: 1) the physical or mental examination of persons; 2) the diagnosis, treatment or prevention of physical or mental defects, illnesses or deficiencies in man humankind; 3) the giving of advice in regard to such defects, illnesses or deficiencies; or 4) the prescribing or providing of medicine in connection with such defects, illnesses or deficiencies. To aid further discussion, we teased out the individual elements of these four forms of health practice. These are shown in Table 2. We re-worded the items into a longer list as shown below.

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Journal of Clinical Neurology and Neuroscience Review article Article id: JCNN-20-09

Table 2: The Defining Health Practice Activities for the Health Professions

Healthcare Acts ABBREV Physical Examination PE Mental examination ME Diagnosis of physical defects, illnesses, or deficiencies. DgP Diagnosis of mental defects, illnesses, or deficiencies. DgM Treatment of physical defects, illnesses, or deficiencies. TxP Treatment of mental defects, illnesses, or deficiencies. TxM Prevention of physical defects, illnesses, or deficiencies. PrP Prevention of mental defects, illnesses, or deficiencies. PrM Advice in regard to physical defects or deficiencies. AdP Advice in regard to mental defects or deficiencies AdM Prescribing Prs

Psychology in the Light of Other Health Professions In order to clarify the contributions of each professional group to the health services, we created the comparison Tables below. Two professions are selected from each board. Because of the special focus on psychology, all the professions on the Psychology board and the Medical, Dental, and Medical Science Board are included in the Table.

Training Comparisons The various professions are compared with respect to the duration of training in years (TD), minimum qualification for practice (MNQ), and the study of basic medical sciences (BMS). For the BMS, we considered both the width and depth of training. The width refers to the number of body systems studied. Some professions focus on learning about one system, and only minimally study the other systems. Other professions study all the systems equally. The depth refers to the extent of subject detail covered during the training.

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Journal of Clinical Neurology and Neuroscience Review article Article id: JCNN-20-09

Table 4: Training Comparisons

Profession Board TD MNQ BMS Width BMS Depth Dent therapists DENT 4 BSc Narrow Moderate Dieticians DIET 4 BSc Narrow Moderate Op Emerg Care Orderly EMER 4 BSc Narrow Moderate Env H Practitioners ENVI 4 BSc Narrow Moderate Med Practitioner MEDI 5 Hons Wide Detailed Med Specialist MEDI 9 MA/MSc Wide Detailed Med Technol MEDT 4 BSc Moderate Detailed Occ Therapist OCCU 4 BA/BSc Moderate Moderate Optometrists OPTO 4 BA/BSc Moderate Moderate Physiotherapist PHYS 4 BA/BSc Moderate Moderate Clin Psychol PSYC 7 MA/MSc Narrow Minimal Couns Psychol PSYC 7 MA/MSc Narrow Minimal Ed Psychol PSYC 7 MA/MSc Narrow Minimal Ind Psychol PSYC 7 MA/MSc Narrow Minimal Neuropsychol PSYC 7 MA/MSc Narrow Minimal Rsch Psychol PSYC 7 MA/MSc Narrow Minimal Psychometrist PSYC 4 Hons Narrow Minimal Reg Counsellor PSYC 4 Hons Narrow Minimal Radiographer RADT 4 BSc Moderate Minimal Speech Therapist SPCH 4 BSc Moderate Minimal ------Auxiliary Nurse ? 2 Cert Wide Minimal Staff Nurse ? 4 B. Cur Wide Moderate Professional Nurse ? 4 B. Cur Wide Detailed

Note: Nursing is not covered by the Health Professions Act, but is covered by the Nursing Act 33 of 2005. We included nursing here because of the interesting comparisons it can provide to psychology. Discussion of Training Comparisons Three features stand out with respect to training of psychologists in South Africa. The first is that psychologists have the longest duration of training amongst the health professions (7 years). The minimum qualification to practice is a Master’s degree, whereas the training for other professions it is a Bachelor’s degree and takes place over 3 to 5 years. The second feature is that the psychology students have a narrow focus on the basic medical sciences. Psychologists minimally study the nervous system, and do not study the other 10 body systems. On the other hand, the professions of Medical, Dental, and Medical Sciences have both wide and deep training in the basic medical sciences. The occupational therapists, optometrists, and physiotherapists all study the basic medical sciences at a wider and more detailed level than the psychologists. The closest that psychologists get to learning the basic medical sciences are courses in psychophysiology. They do this without formal training in chemistry or biochemistry, which are essential to a full understanding of the nervous system. Furthermore, psychologists limit their studies of anatomy and physiology to the central nervous system, and do not formally study other body systems, such as the ©CIENCIA SCIENTIFIC PUBLISHER PVT.LTD

Journal of Clinical Neurology and Neuroscience Review article Article id: JCNN-20-09

circulatory system, immune system, and others. This means that psychologists have a necessarily narrow and limited appreciation of the nervous system and its interdependence with other body systems. Notwithstanding the narrow training, the psychologists are able to contribute significantly to the assessment and rehabilitation of patients with brain disorders. The psychologists could contribute much more than they do currently, if they added the broad range of basic medical sciences to their training. A Google search on the undergraduate and postgraduate courses offered at four South African Universities (University of the Witwatersrand, University of Pretoria, University of South Africa, and University of the Western Cape) showed that they differ a lot from each other. What they seem to have in common is the fact that there is little or no teaching on neuroscience or pharmacology. These South African universities lie firmly on the “mind” end of the mind-body dualism. Comparisons on Healthcare Activities by Profession We compared the health professions against the health care acts listed in Table 3. For each profession, we made classification decisions based on the scope of practice as published by the Health Professions Council of South Africa (2011) (18). Only therapeutic professions are included (e.g. medical technicians are excluded). On this Table the ratings are as follows: 1 = Part of scope of practice. 0 = Not part of scope of practice ? = Maybe Table 5: Healthcare Procedures

BRD PE ME DgP DgM TxP TxM PrP PrM AdP AdM Prs Dent therapists DENTAL 1 0 1 0 1 0 1 0 1 0 1 Dieticians DIET 0 0 0 0 1 0 1 0 1 0 0 Op Emerg Care EMERG 1 0 0 0 1 0 0 0 1 0 0 Orderly Env H Practitioners ENVIR 0 0 0 0 0 0 1 0 1 0 0 Med Practitioner MEDICAL 1 1 1 0 1 0 1 0 1 0 1 Med Specialist MEDICAL 1 1 1 0 1 0 1 0 1 0 1 Medical Specialist MEDICAL 1 1 1 1 1 1 1 1 1 1 1 (Psychiatrist) Medical Specialist MEDICAL 1 1 1 0 1 0 1 0 1 0 1 (other) Occupational OCCUP 0 1 0 0 1 1 1 1 1 1 0 Therapist Optometrists OPTOM 1 0 0 0 1 0 1 0 1 0 1 Physiotherapist PHYSIO 0 0 0 0 1 0 1 0 1 0 0 Clinical PSYCHOL 0 1 0 1 0 1 0 1 0 1 0 Psychologist Counselling PSYCHOL 0 1 0 1 0 1 0 1 0 1 0 Psychologist Educational PSYCHOL 0 1 0 1 0 1 0 1 0 1 0 Psychologist Industrial PSYCHOL 0 1 0 1 0 1 0 1 0 1 0 Psychologist Neuropsychologist PSYCHOL 0 1 0 1 0 1 0 1 0 1 0 Research PSYCHOL 0 1 0 1 0 0 0 1 0 1 0 Psychologist Psychometrist PSYCHOL 0 0 0 0 0 0 0 1 0 0 0 ©CIENCIA SCIENTIFIC PUBLISHER PVT.LTD

Journal of Clinical Neurology and Neuroscience Review article Article id: JCNN-20-09

Reg Counsellor PSYCHOL 0 0 0 0 0 1 1 0 1 0 RAD & Radiographer 0 0 0 1 0 1 0 1 0 0 TECH

Auxiliary Nurse - 1 0 0 0 1 0 1 1 1 0 0 Staff Nurse - 1 0 0 0 1 0 1 1 1 0 0 Professional Nurse - 1 0 0 0 1 0 1 1 1 0 0

Key: Health Practice Processes PE: Physical Examination; ME: Mental Examination; DgM: Diagnosis Physical; DgM: Diagnosis Mental; TxP: Treatment Physical; TxM: Treatment Mental; PrP: Prevention Physical; PrM: Prevention Mental; AdP: Advise Physical; AdM: Advise Mental; Prs: Prescribing Comments on Defining Health Practitioner Activities The professions in the Medical and Dental Boards predominate in both the diagnosis and treatment of physical disorders. After 7 years of training, psychologists graduate with a limited role in the provision of health care because of their limited training in Basic Medical Sciences. Medical practitioners are the most versatile of all the professions in the list. They have at least a working knowledge about what happens in all the other 11 professional groups. Psychologists are among the professionals who traverse a narrow lane, and have limited knowledge about all the other 11 professional groups. The general practitioner is not a specialist (psychiatrist), but has the capacity to treat mental disorders with medication and limited psychotherapy. The psychologist’s knowledge of medical disorders, apart from psychiatric disorders, is not necessarily higher than that of non-health practitioners.

The Negative Impact of Mind-Body Dualism What’s in a name? Some readers may wonder whether it really matters what name is used to describe the academic discipline currently known as psychology. Using gender discrimination as a historical example, this question is akin to stating that the person who chairs a meeting should be called a chairman, irrespective of whether it is a male or female. This was acceptable before the women’s movement against discrimination, but the name is not acceptable now. By changing vocabulary, there came universal awareness of how words used can support a narrative justifying systemic discrimination. In a similar vein, we propose that psychologists should change the entire language of psychology, including the word psychology itself. Failure to do so is like insisting on wearing a wrong label. It is potentially harmful, and has proved to be so, as discussed below: Mind-Body Dualism is an Irrational Basis for a Health Profession No scientific evidence has yet been provided that the mind exists as an immaterial substance, separate from the body and interacting with it. There is thus no assurance that the concepts and practices based on this claim correspond to reality. The name “psychology” and related concepts is an acceptance of the claim of mind-body dualism on faith. It is irrational to accept claims for which there is no evidence. The philosophy of mind-body dualism is therefore not acceptable as a foundation for a scientific discipline and a profession.

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Journal of Clinical Neurology and Neuroscience Review article Article id: JCNN-20-09

Mind-Body Dualism is the basis for discrimination against “Mental” Disorders and Psychologists As was mentioned earlier (4), cartesian dualism allowed medicine to escape from the oversight of religion, to focus on physical disorders. Mental disorders were thus relegated to a secondary position within medicine. Mental disorders are stigmatized. The resources allocated to mental disorders and remuneration for psychologists is lower than that for medical disorders and medical practitioners. Apparently, in an attempt to justify low payment scales for psychologists, some medical aid societies classify psychologists as “Allied Professions” or “Therapists”. The correct position is that psychologists should be classified as health practitioners, alongside medical practitioners, physiotherapists, and others, as the law indicates. Organizations, such as medical aid societies, find loopholes to discriminate psychologists, because the psychologists themselves accept, and practice according to the parameters by the philosophy of mind- body dualism. These are self-inflicted wounds. Lack of Professional Independence for Psychology. According to the HPCSA, the profession of psychology is comprised of psychologists (clinical, educational, counselling, industrial, research, & neuropsychology), psychometrists, and registered counsellors. These professionals are all registered as independent practitioners. In reality, these professions are not independent, as shown by the following facts:  South African law allows psychologists to admit patients to hospitals, provided they can show, within 24 hours, that a medical practitioner will be engaged. This arrangement disadvantages both the patient and the psychologist: The admission of the patient is delayed whilst the psychologist phones around to find a psychiatrist to confirm admission. The compulsory involvement of the psychiatrist leads to the undesirable situation where every patient will be put on a course of medication whether the psychologist thinks this is necessary or not. In contrast, the psychiatrist can instantly admit a patient by phoning a ward to check if there is a bed available. There is no requirement for a psychologist to be available. Clearly, psychiatrists are independent practitioners, and psychologists are not as independent.  Some medical aid societies will not pay psychologists until the psychologist produces proof that the patient had been referred by a psychiatrist. A ridiculous situation then arises, where a psychologist refers a patient to a psychiatrist, then asks the psychiatrist to confirm to the medical aid that the psychiatrist had referred the patient to them! Registered counsellors and psychometrists are even less independent than psychologists. The reason for the lack of independence is not necessarily because medical aid societies and hospital are unfair to psychologists. Rather, the reason is that the psychologists do not have the skills needed to make them truly and fully independent.  Psychiatrists are more versatile than psychologists with regards to the services they offer, and therefore get to be given more authority and financial rewards. The problem lies with the fact that due to the influence of dualism, psychologists have little or no training in basic medical sciences.  Cartesian dualism encourages problematic dysfunctional hierarchical relationships amongst healthcare providers. This is evidenced by the fact, for instance, that the psychiatrist is the de facto head of the psychiatric team. In that position, the psychiatrist makes final patient management decisions with which the psychologist may disagree, such as need to admit or discharge a patient. The fact that the psychiatrist is head of the psychiatric team is understandable, given that psychologists have a narrow scope of practice. They are not as clinically versatile as the psychiatrists are.

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Journal of Clinical Neurology and Neuroscience Review article Article id: JCNN-20-09

Mind Body Dualism and Lack of Training in Basic Medical Sciences In South Africa, the training of psychologists takes place mainly in the Faculties of humanities and social sciences. Why is this the case, when psychology is officially a health profession? The logical arrangement would have been for psychology to be either a department in the Health Sciences faculty, or an independent faculty in its own right. Ironically, after qualifying graduating from the humanities and social sciences, clinical psychologists spend their working lives in hospitals. The location of psychology within the Humanities and faculties is a major constraint on the development and evolution of the discipline. Cooper and Nicholas (19) found that after, the academic subject of law, psychology is the most popular subject in the Humanities and Social Science faculties. Psychology generates huge revenue because of the large number of students who enroll for elective courses. This does not benefit the psychology profession, or the health services, but rather, it financially benefits the academic faculty which controls the discipline. One can expect that if psychology attempts to relocate to another faculty, or to become an autonomous faculty, this would be strenuously resisted by leaders in the humanities and social sciences. The major negative impact of psychology training outside the Health Sciences faculties is that they do not acquire the basic skills required of all other health professionals. This includes simple skills like assessment of vital signs or first aid. Further than this, psychologists are not trained to recognize medical conditions other than some psychiatric disorders. These are professional handicaps, and they are the basis for lack professional independence by psychology professionals. When psychologists are attending to hospitalized patients, they work under the shadow of psychiatrists. The psychiatrists make the decisions about patient admission and discharge. They also decide which other who, for example, decide when and if, a patient will be admitted or discharged. Patients admitted to hospitals are registered under a psychiatrist, and the psychiatrists get paid more for performing psychotherapy. As indicated earlier, psychologists lack professional versatility within the field of health. As a consequence, they can offer the public only a narrow range of services. The range is so narrow that the psychologist, despite being a health professional, cannot offer the simplest of medical assessments, such as assessing vital signs, and basic but important or interventions such as First Aid. This is all due to the belief that the psychologist should only attend to people’s minds. Because of this, the psychology profession is a weak link in the provision of health services. The COVID-19 pandemic saw psychologists unable to offer more than counselling, when security guards, and other people with no health training, were checking people’s temperature all over the country. It is important for psychologists to increase their versatility and scope of practice because of the severe shortage of workers in South Africa. According to the WHO-AIMS Report (20) on Mental Health System in South Africa (2007), the human resource situation in the country is as follows: Per 100, 000 population, there are 0.28 psychiatrists, 0.45 other medical doctors (not specialized in psychiatry), 7.45 nurses, 0.32 psychologists, 0.4 social workers, 0.13 occupational therapists, 0.28 other health or mental health workers. These numbers exclude health practitioners in private practice. The distribution of human resources between urban and rural areas is disproportionate, with more practitioners in the cities than in the rural areas. In the mental hospitals, the number of staff per bed is 0.2 psychiatrists and 0.5 psychologists. Statistics on health expenditure was available only for 3 provinces (Northern Cape 1%, Mpumalanga 8%, and North West 5%).

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Journal of Clinical Neurology and Neuroscience Review article Article id: JCNN-20-09

Recommendations Based on issues discussed to this point, we make a call for action to be taken to make changes to the training and practice of psychology in South Africa. This call goes out to all individual psychologists in South Africa, psychology associations in South Africa and the rest of Africa, universities, and regulatory authorities. We set out below, PATISA’s preliminary proposals for changes to be made to the university training of psychologists (Behavioural ) and the setting up of a specialist register. 1. A new vocabulary for psychology Many terms and expressions in the language of psychology reflect the influence of mind-body dualism. We propose that task groups should be set up to identify and replace vocabulary items which promote mind- body dualism. A preliminary list is shown in Appendix B. 2. Overhaul of Training for Psychologists We propose a Task Team to work out the curriculum of both the undergraduate and post-graduate degree, in the light of the inadequacies of both the training and practice of psychology which we have identified. Anatomy and physiology are the bedrocks of the health sciences. It is imperative that the psychology profession should study these subjects, as is the case with all the other health professions. Currently, psychology students only study at a minimal level, and do not study the other body systems. The proposed new training will require the study of all systems, at a level of detail appropriate for a psychologist with a wider scope of practice. (a) Undergraduate Psychology (4 Years) We recommend a four-year degree for the following reasons:  We note the waste of human resources associated with the current Bachelor’s degree for people wishing to enter the psychology profession. Many of these graduates are unemployed, when they could be contributing to health services. After the three-year degree, these graduates are not equipped to provide health services.  We note that other health professions, like occupational therapy and physiotherapy graduate with four-year degrees which allow them to practice. There is no reason why the psychology graduates cannot be given the same opportunity, so that they can join the health services as psychometrists and registered counsellors after one year of internship. Previously, a suggestion was put to the HPCSA for a B Psych degree, which had the same objective. With this in mind, we propose the following features for the undergraduate degree  Psychology I  Psychology II  Psychology III  Human Anatomy  Human Physiology  Overview of biochemistry  Medical terminology and  Introduction to pharmacology

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Journal of Clinical Neurology and Neuroscience Review article Article id: JCNN-20-09

 Psychophysiological Assessment (All body systems)  Basic Medical Assessment and intervention (Vital signs, Review of Systems [ROS], and First Aid).  Perhaps one or two elective courses from other faculties.  For Psychology I, II, and III, the course should include the neurophysiology of all the psychological processes and states under discussion. For example, the course on Learning would cover material on the physiological changes at the synapse as a result of learning.  Applications of behavioural neuroscience to clinical, industrial, and educational settings.  We propose that students graduate with the following degree: - BSc (Behavioural Neuroscience). Proposed HPCSA Registration after BSc (Behavioural Neuroscience) - Behavioural Neuroscience Technician - Scope: Psychometry (current scope), basic medical assessment, counselling, basic medical interventions. We expect that this degree structure would be difficult to implement within the Faculties of Humanities or Social Science. The ideal is that psychology should have its own Faculty, so that it can take full control of its discipline. Alternatively, psychology should become a department in the Faculty of Health Sciences. (b) Master of Science Degree  We propose that all Masters students enroll for one degree, which allows them to go into general practice in psychology. Specialization is to be done after the Master’s degree.  The degree would be: Master of Science (Behavioural Neuroscience).  All current course work for Master’s degrees in Industrial, educational, clinical, counselling,  Clinical medicine  Pharmacology  Projects on application of neuroscience to industrial, educational, or clinical. Master’s degree - Master of Science (Behavioural Neuroscience). Proposed HPCSA Registration Category - Behavioural (General Practice).

Widening the Scope of Practice for Psychology (Behavioural Neuroscience) We propose the expansion of the current scope of practice for psychologists. The current scope is very narrow because the philosophy of dualism restricts psychologists to only “mental” assessments and interventions. In the absence of dualism, there is no justification for prohibiting more holistic work with patients. This should allow more services, including basic physical assessments (e.g. Vital signs, Review of Systems, and medical laboratory testing), and basic physical interventions.

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Journal of Clinical Neurology and Neuroscience Review article Article id: JCNN-20-09

As health professionals in a country with shortages of personnel, all the psychology professions should be trained to do basic health work which does not confine them to mental processes only. In other words, at schools, industries, and other settings, psychologists should be able to provide a wider range of services than is currently the case. In the absence of nurses or medical practitioners, the psychologists, as health practitioners, should be the first port of call for any medical problems. A good grounding in what is currently known as applied psychophysiology (biofeedback) will enable psychologists to be knowledgeable and effective members of most medical teams. Specialist Registers for Psychology As it became clear from a comparison of the health professions in Table 8, there is no specialist register for psychology. Currently, the HPCSA has registers for 6 categories of psychologists, namely clinical, educational, industrial, counselling, research, and neuropsychology. These are not specialist practitioners, because registration is based on the minimal qualification for practice, which is the Master’s degree. The absence of a specialist register is an unsatisfactory state of affairs, because there is no recognition of further education and expertise. When a psychologist acquires a doctorate, they can apply for an HPCSA certificate which states that they have an additional qualification, but this has no effect, most notably, on income. In private practice, medical aid societies pay the same fee to a psychologist who has just qualified, as it pays to a psychology professor with doctorates, postdoctoral qualifications, publications, and vast experience. PATISA proposes that admission to the psychology specialist register should be based on appropriate university qualifications beyond the Master’s degree. We tentatively propose the following specialist registers: - Specialist Behavioural Neuroscientist (Educational). - Specialist Behavioural Neuroscientist (Clinical) - Specialist Behavioural Neuroscientist () - Specialist Behavioural Neuroscientist (Industrial). - Specialist Behavioural Neuroscientist (Research) - Specialist Behavioural Neuroscientist (Pharmacology) We propose merging the current register of counselling psychology and neuropsychology, with the current category of . with Specialist Behavioural Neuroscientist (Clinical) for the following reasons: - First, “neuropsychology” is a misnomer because it implies that the subdiscipline deals with the brain, whilst other branches of psychology do not. This is not correct because all of psychology is brain based. Second, the curriculum of the proposed undergraduate and postgraduate degrees requires the study of the brain and other body systems to a much deeper and broad extent than current neuropsychology. - There is almost no difference between the practice of counselling psychology and clinical psychology. The only difference in practice is that counselling psychologists have a more restricted scope of practice, which is a source of unnecessary frustration for these practitioners. The supposedly less serious psychological problems which the counselling psychologists are supposed to focus on, are as biological as the conditions treated by clinical psychologists and psychiatrists.

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Journal of Clinical Neurology and Neuroscience Review article Article id: JCNN-20-09

The current disciplines of clinical psychology, counselling psychology, and neuropsychology then all merge into one profession: Specialist Behavioural (clinical). Specialist Training for Currently Registered Psychologists It will take years to have the first batch of specialist psychologists based on the recommendations in this paper. We propose that psychologist already in practice should be given the opportunity to register as specialists after 2 years or so of formal training by way of special CPD programs or other means of additional training. Taking into account that currently practicing psychologists do not have a background in basic medical sciences, the training would put special emphasis on basic medical sciences. The rest of the training will be on applications of behavioural neuroscience to the specialist fields of clinical, educational, industrial, and research psychology. We recommend that that all prospective specialists should complete a project on the application of neuroscience to their chosen area of work. Training for the Specialist Behavioural Scientist (Pharmacology) could be along the lines of the APA approved programs (21) for the Postdoctoral MSc in Clinical for clinical psychologists. https://www.apadivisions.org/division-55. This qualification would allow psychologists to prescribe psychotropic medications. The US Department of Defence was first to accept the proposal of prescribing psychologists and implemented a training program. The first two prescribing psychologists graduated from the US Navy’s psychopharmacology training program in 1994. Since then, legislations allowing appropriately trained psychologists to prescribe were passed in New Mexico, Louisiana, Illinois, Iowa, and Idaho. The American Psychological Association (APA) developed training guidelines for the Postdoctoral MSc in Clinical Psychopharmacology for psychologists. Psychologists graduating from these training programs have been prescribing safely and effectively in the USA for more than 28 years. A study by Shearer, Harmon, Seavy, and Tiu (22) found as follows: “Results indicate family medicine providers agree that having a prescribing psychologist embedded in the family medicine clinic is helpful to their practice, safe for patients, convenient for providers and for patients, and improves patient care” (p. 420). Similarly, Linda and McGrath (23) conducted a survey, which found that prescribing psychologists were overwhelmingly perceived positively by their medical colleagues across various domains. These domains included ratings on adequacy of training to prescribe medication, adequate knowledge of medical terminology, knowledge of medical tests relevant to prescribing, appropriate consultation with other medical professionals, knowing when it is appropriate to refer to other medical professionals, and increasing patient access to care.

Conclusion It is apparent from the foregoing that the need to replace the word “psychology” as a label of the discipline with the more appropriate “behavioural neuroscience” is long overdue. We have demonstrated that the conceptual and practical justification for the call for alignment of the vocabulary of the discipline with the reality of the attendant professional reality is self-evident. The specific example of the South African context as one that perpetuates the mind-body dualism and its adverse consequences demonstrates the urgency of engaging on the recommendations outlined. This will require both national and international groupings of the profession to have transparent , driven by a quest for migrating the profession into the twenty-first century and setting the platform for centuries to come.

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Journal of Clinical Neurology and Neuroscience Review article Article id: JCNN-20-09

References

1. Health Professions Act 56 of 1974. https://www.hpcsa.co.za/Uploads/Legal/legislation/health_professions_ct_56_1974.pdf 2. Finkel B. Biography: Rene Descartes. The American Mathematical Monthly. 1898; 191-195. doi: 10.2307/2969353. 3. Gendle MH. The Problem of Dualism in Modern Western Medicine. Mens Sana Monographs. 2016; 14:141–151. 4. Mehta N. Mind-body dualism: A critique from a health perspective. Mens Sana Monographs. 2011; 9:202–209. 5. Walker K. The Story of Medicine. New York: Oxford University Press. 1955. 6. Blumenthal AL. Wilhelm Wundt and Early American Psychology. In: Rieber R.W. (ed), Wilhelm Wundt and the Making of a Scientific Psychology. Path in Psychology. Springer, Boston, Mass 1980. doi: 10.1007/978-1-4684-8340-6_4. 7. Robinson DK. Reaction-time experiments in Wundt’s Institute and beyond. In Rieber, R.W. (ed), The making of scientific psychology, Springer Science & Business Media.2001, pp. 161-204. 8. Mureriwa JFL. Common Factors in Psychotherapy: The autonomic nervous system common pathway. Current Advances in Neurology and Neurological Disorders. 2017a; 1:1-12. 9. World Health Organization Constitution. Geneva: World Health Organization, 1947. 10. Mureriwa, JFL. (Reprint). Psychology is Entirely Physical: Taking the Mind out of Behavioural Neuroscience. Lambert Academic Publications. International Book Market Service Ltd, 2017b. 11. Lim MM, Szymusiak R. Neurobiology of Arousal and : Updates and Insights into Neurological Disorders. Curr Sleep Medicine Rep.2015;1: 91-100.doi: 10.1007/s40675-015-0013-0. 12. Zhao T, Zhu Y, Tang H, et al. Consciousness: New Concepts and Neural Networks. Front. Cell. Neurosci. 2019; 13:302. doi: 10.3389/fncel.2019.00302 13. Kandel ER. Psychotherapy and the single synapse: The impact of psychiatric thought on neurobiological research. Journal of and . 2001; 13:290-300. 14. Jiang X, Shen Y, Yao J, et al. analysis of functional and structural hemispheric brain networks in major depressive disorder. Transl Psychiatry. 2019; 9:136. doi:10.1038/s41398-019- 0467-9 15. Eichenbaum H. Memory: Organization and Control. Ann Rev Psychol. 2017; 68:19-45. doi:10.1146/annurev-psych-010416-044131. 16. Cody H, George W. Neuropsychological advances in Child & Adolescent Mental Health. The Decade of the Brain. Child Psychology & Psychiatry Review. 1999; 4:103-108. doi: 10.1017/S136064179900194X 17. Leefman J, Hildt E. The Human Sciences after the Decade of the Brain. Elsevier Academic Press,2017.

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Journal of Clinical Neurology and Neuroscience Review article Article id: JCNN-20-09

18. Government Notice 34581. Health Professions Act No. 56 of 1974, 2011. https://www.hpcsa.co.za/Uploads/PSB_2019/Rules%20and%20Regulations/regulations_gnr993_20

08. 19. Cooper S, Nicholas L. An overview of South African Psychology. International Journal of Psychology. 2012; 47:89-101. 20. World Health Organization. WHO-AIMS report on mental health system in South Africa. 2007. 21. American Psychological Association, Division 55, American Society for the Advancement of Pharmacotherapy. https://www.apadivisions.org/division-55. 22. Shearer DS, Harmon CS, Seavey BM, et al. The primary care prescribing psychologist model: Medical provider ratings of the safety, impact and utility of prescribing psychologist in a primary care settings. Journal of Clinical Psychology in Medical Settings. 2012;19:420-429. 23. Linda WP, McGrath RE. The Current Status of Prescribing Psychologists: Practice Patterns and Medical Professional Evaluations. Professional Psychology: Research and Practice.2017;48:38-45.

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Journal of Clinical Neurology and Neuroscience Review article Article id: JCNN-20-09 Appendix A List of Health Professions under the HPCSA

Abbreviations are our own- they are not given as such in the Act

Professional Board Abbreviation List of Professions

Dental Assisting, Oral hygienists. Dental therapists. Dental assistants. DENT Dental Therapy, and Oral Hygiene. Dieticians. Supplementary dieticians. Nutritionists. Student Dietetics and Nutrition. DIET nutritionists. Supplementary Nutritionists.

Basic Ambulance Assistants (BAA). Ambulance Emergency Assistance (ANA). Operational Emergency Care Orderly Emergency Care. EMER (OECO). Environmental Health. Student Environmental Health Practitioners. Food Inspectors. Environmental Health Environmental Health. ENVI Assistants. Medical Practitioners. Clinical Associates. Medical Specialists. Medical, Dental, and Dental Practitioners. Dental Specialists. Genetic Counsellors. Medical Science. MEDI Medical Physicists. Medical Biological . Medical Laboratory Scientist. Intern Medical Laboratory Scientist. Student Medical Laboratory Scientist. Medical Technologists. Intern Medical Technologists. Student Medical Technologists. Medical Medical Technology. MEDT Technicians. Student Medical Technicians. Supplementary Medical Technicians. Laboratory Assistants. Student Laboratory Assistant. Supplementary Laboratory Assistants.

Occupational Therapist. Supplementary Occupational Therapist. Occupational Therapy, Occupational Therapy Technicians. Medical Orthotics and Medical Orthotics, Prosthetics. Orthopaedic Footwear Technicians. Orthopaedic OCCU Prosthetics, and Arts Technical Assistants. Assistant Medical Orthotics and Prosthetics & Therapy. Leatherworks. Arts Therapist: Drama, Music, Art & Movement.

Optometry and OPTO Dispensing Opticians. Students Dispensing Opticians. Supplementary Dispensing Opticians. Optical Dispensers. Student Supplementary Optical Dispensers. Supplementary Optometrists. Optometrists. Student Optometrists. Orthoptists.

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Journal of Clinical Neurology and Neuroscience Review article Article id: JCNN-20-09

Physiotherapy, PHYS Physiotherapists. Podiatrists. Biokineticists. Podiatry, and Biokinetics. Intern Psychologists. Student Psychologists. Registered Counsellors. Psychometrists. Student Psychometrists. Student Registered Counsellors. Psychology. PSYC Clinical Psychologists. Counselling Psychologists. Educational Psychologists. Industrial Psychologist. Neuropsychologist. Research Psychologist.

Student Radiographers. Radiographer (Diagnostic, Ultrasound, Radiation Radiotherapy and Therapy). Student Clinical Technologists. Clinical Technologists. Graduate Clinical RADT Clinical Technologists. Student Electro Encephalographic Technicians. Electro Technology. Encephalographic Technicians.

Speech Therapist. Speech Therapist & Audiologist. Audiologist. Hearing Aid Acousticians. Audiometrician. Supplementary Audiologist. Supplementary Speech, Language, SPCH Hearing Aid Acousticians. Supplementary Speech Therapy and Audiology. and Hearing. Speech Hearing and Correctionist. Community Speech and Hearing Worker. Speech Therapy Assistant. Speech and Hearing Assistant.

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Journal of Clinical Neurology and Neuroscience Review article Article id: JCNN-20-09

Appendix B Sample Tentative Glossary of Some Psychological (Behavioural Neuroscience) Terms Note: It requires a Nomenclature Task Force to compile a Glossary of Terms. What is given below are merely tentative items, to provide a sense of what is required

Current Term Proposed Term Mind Discontinue term Mental (Relating to mind) Discontinue Mental illness Behavioural disorder Mental health Health Physical health Health Mind over matter Discontinue: Relates to mind Psychology Behavioural neuroscience Psychologist Behavioural neuroscientist Psychological Behavioural Psychotherapy Behavioural treatment Psychosocial Replace with: Behavioural or Social Psychological and emotional problem Emotional problem. Behavioural physiology, or Physiology of behaviour. Biological psychology Behavioural biology, or Biology of behaviour. Neuropsychology Behavioural neuroscience Psychosomatic illness Discontinue Discontinue false dichotomy: Specify diagnoses, e.g. Medical vs psychological illness respiratory problem with depression Trauma: Specify problem, e.g. chest injuries and emotional Physical and emotional trauma distress Specify the elements, e.g. torture involving beatings and Physical and emotional torture verbal abuse. Inter-changeable: Treatment or Therapy Treatment vs therapy

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