Episode 5 - Dr Trevor Powell
Trevor: [00:00:00] My name's Dr. Trevor Powell. I'm a consultant clinical neuropsychologist. And I'm the lead for the neuropsychology service in Berkshire. Within that service, we have, psychologists who work in inpatient neuro rehab units, in community units, and we also have psychologists that work with neuro diverse people, such as people with autism and ADHD.
So, it's a service that's across the board in terms of people who's brain has either been injured or have a slightly differently wired type of brain which affects thinking and expression, language,
etc.
Rob: Dr. Powell, welcome to our podcast on the tip of my tongue, and it's very generous of you to give us your time. Can I start by saying, I mean, obviously you've dedicated your life to helping people with mental health [00:01:00] issues, and just reading The titles of three of your books, for instance.
Best selling books, I might add. Head Injury, A Practical Guide. The Brain Injury Handbook, The Mental Health Handbook. Just reading those titles Prompts me to wonder, first question, are we just plain wrong, and by we I mean me, the ordinary person, man in the street
are we just plain wrong to think of mental health as somehow separate and different to physical health? The brain being just an organ like the heart or whatever, and things go wrong with the brain as they do with other organs. When something goes wrong with the brain, we call the consequences of that mental health issues.
But should we just call them health issues and cut out a lot of prejudice and stigmatization? I wonder what you thought of that.
Trevor: Well I think that, physical health Mental health [00:02:00] are intertwined, I mean the notion of mental health. I would be more comfortable with psychological processes, but people have. Any kind of physical health condition, there are a whole raft of psychological processes, even any kind of pain experience of sensory pain You're interpreting that in a, in a psychological way.
So to separate them out I don't think it's helpful and I think people are beginning to realize the into linkage between psychological processes and physical health. In fact, I heard someone the other day say, Oh yes, I think the placebo effect is quite strong. Actually there's been a library of research saying the most significant treatment effect, forget any kind of medication, is a placebo effect.
So, for someone to say off the top of their head that they personally think that is the placebo effect [00:03:00] works, like saying the earth is round. Of course it works. It's a fact. Does that make
Rob: So we don't need to give any drugs or medication. We just Give people sugar pills and tell them they work
Trevor: Not dismissing drugs and medication at all. But the expectation that somebody has and the interpretation of their symptom is always something worth looking at. And in fact, in most health services now, psychology in The general hospital is quite a significant aspect of whether it be rheumatology, end of life care, cancer treatment , whether whatever, there's psychologists working on all these things, and they are not just working with people with mental health problems.
It's not like, oh. This person's mad, we need a psychologist to see them.
Rob: Can I ask, I know you're a neuropsychologist that's a new term on me. I think most people would have, they might think they know anyway, about what [00:04:00] psychology is about. Study of the mind and behavior. I suppose everything from rats in mazes to lying on a couch having your dreams analyzed. But, what is neuropsychology, and are there any rats and are there any couches involved?
Trevor: Neuropsychology is a branch of clinical psychology. Neuropsychology is about. The relationship between brain and behavior specifically Neuropsychology as a discipline in the UK started life centered around post second world war veterans returning from the battlefield with bullet injuries. Then in 50s and 60s looking more at head injuries in motor vehicle accidents and then looking at stroke and other kind of vascular disease and dementia and all these different areas.
Neuropsychologists work in all these different areas. I'm a I [00:05:00] look with interest at Joe Biden and can't, for the life of me, understand why There isn't a discussion about insight , some eminent Democrat said, Oh, well, you know, we'll leave it to Joe to make the decision.
Now, when your brain is atrophizing and shrinking the person doesn't often have the insight and awareness to understand what's going on. Someone interviewed him and said Oh, Mr. Biden, after the debate with President Trump, did you watch the video of it? Good question.
He said something like I don't know.
If he said, if he said, I didn't know whether I watched the recording of the debate, does that mean he can't remember, and he didn't know? If so, he's got a cognitive problem. I don't think so means, It was such an important debate, you should have watched it if you are cognitively [00:06:00] intact
Insight is a key dimension in any kind of brain injury, whether it's stroke or head injury. That's the ability to look in the mirror. and identify your own strengths and weaknesses. And that's one of the things that is located in the frontal part of the brain. And often if people have a traumatic brain injury, where their head's thrown forward The front bit of the frontal lobes get damaged and people lose insight and similarly with dementia.
I remember my father had dementia and we had to say to him, look dad you can't drive, he wouldn't accept it. As is the case with a lot of people. Oh, I've driven for 50 years, I can drive okay. And you have to explain to him in detail that his ability to divide and switch his attention was impaired.
And eventually, and with a great deal of pressure, he accepted,, I won't drive . Now, that's what [00:07:00] someone needs to do with Joe Biden.
Rob: One of the questions I'd actually written down, because I know you do a lot of psychometric testing, you do assessments of people's cognitive functions and so on. I thought, if we were in America, you're the go to guy to tell us whether Joe Biden should continue to be president.
One of the problems with mental deterioration, and the problems that he may have mentally, is that he, he's lost this ability to, as you say, look in the mirror and diagnose, things. I don't think I'm up to this anymore, it is frightening, isn't it? Just coming back to you?
Is that why, how you got into it? Was it because of your father's dementia that led you to an interest in all
Trevor: I, I sort of stumbled into psychology almost by accident, got into clinical psychology and then got into neuroscience,. Then I got involved with a charity called Headway,
which One of my patients a guy had a head injury in a road traffic accident. Came [00:08:00] along with his mother one day and his mother who had set up a local branch of Headway in the old casualty department of the one of the general hospitals in Reading and she rang me the next day and said, Oh, would you like to be the chairman of the charity? To which I said, well, what does that involve? I was chairman of that charity for about 34 years. So I got involved in the charity and then I reshaped my job because there was such a need, there was a great unmet need for young people who'd had a brain injury. So the Physical Health Services would, save people's lives, and they'd have short rehabilitation on a rehab ward, and then they'd be tipped out, and There was nothing for them. And this is what this lady, said you know, her son was probably about 35, he'd had this dreadful brain injury, and there was nothing [00:09:00] for him.
He didn't fit into any particular service, and so she set up the charity which was one of the About a hundred different groups affiliated to the Headway, the Brain Injury Association.
Rob: What is it you were doing with, in this charity? What, you were just working, you were working obviously with young people predominantly, or anyone who's had a head injury.
Trevor: I used to run a weekly, what was called the memory training group. So I would stand in front of a group of 10 or 12 people for an hour, and we would look at different exercises for improving your memory. It was a kind of mixture of therapy and cabaret, basically. But it was good that people with similar problems came together, and it was also useful to learn strategies for coping with a significantly impaired short term memory.
And it was also quite good fun. People used to come and, you know, have a [00:10:00] laugh. but also pick up a few tricks, a few strategies for coping. In fact, the book, The Brain Injury Workbook that you mentioned is based on those exercises. Cognitive rehabilitation exercises that were started in that group.
So it initially was looking at strategies for improving memory, attention, executive abilities, and then it kind of moved on to more issues around emotional adjustments and insight and awareness about brain injury. But the focus was on living with a brain injury. So you had various components. , a bit of academic knowledge, a bit of practical skills, but what it did was bring people together and that's probably the most therapeutic element.
You go together, you're in a group, there's some facilitator, some psychologist, you've got a few things to do, but People exchanging their experiences and [00:11:00] information you know, is extremely helpful.
Rob: Obviously this podcast is mainly concerned with aphasia. Was just wondering, could we talk a bit about the language functions? Of the brain. I mean, we've talked on this podcast about different types of aphasia.
Tell us about the brain and language. Give us some insights . Is the brain compartmentalized into different areas that deal with different things? Is it all separated or is it a much more fluid or complicated thing?
Trevor: I suppose the answer to that is both, that there are specific areas that are linked to either language production or, Receiving language. So, expressive aphasia is kind of linked to Broca's area. Receptive aphasia is linked to Wernicke's area. They're both in the left hemisphere.
So, the [00:12:00] expressive language. is in between the kind of temporal lobe and the frontal lobe. That's the area of the brain. So if you have a stroke in that area, now a stroke is a very focal insult of the brain, you might well lose your ability to use language expressively. If you have a stroke in the Wernicke's area, you might well lose your ability to understand language, particularly if it's spoken quickly or there are too many clauses involved but it's understanding of language.
So those are both kind of focal insults caused by a stroke. If you have a head injury, basically your brain gets shaken up and rather than having specific focal deficits in those area, you get a more generalized problem with word finding and understanding [00:13:00] language. So stroke tends to be more, zeroed in on particular deficit. Head injury or traumatic brain injury is more of a kind of generalized injury which affects memory, attention, executive ability, but and language to a degree. So so you can have a head injury and it might affect your ability to speak, but your understanding of language might be fine.
I can remember a young head injured lady and she could only say a couple of words. She could say yes, yes, yes, yes, , no, no, no, no, no. I knew she could understand what you were saying. Said something like in front of this woman. Oh, what do you think Karen's mental age is? To which Karen understood every word of it. She stuck up two fingers to this woman was very angry and I had to say, well I [00:14:00] think her mental age is 24.
What is your mental age if you don't understand that? That saying that in front of someone who might have an expressive language problem is not a very sensitive thing to do.
Rob: Is it the case, because one of the missions, of our podcast is to try and dispel prejudices about aphasia. Is it the case that because when you have a problem with your speech, be it receptive or or expressive, that immediately, as you've just demonstrated in your story people Immediately think, oh, you know, they've lost their marbles, or they've got Alzheimer's, or they've got dementia.
Whereas just have a sort of problem with your language.
Trevor: If someone, if their language skills are not particularly fluent people assume that, their cognitive abilities aren't fluent. But that's not always the case
Rob: We used a little analogy with a computer. If you say got Say the hard drive and the [00:15:00] software on the computer, if we think of the brain as something like a computer with a hard drive and software and so on, if dementia and Alzheimer's Can attack the actual hard drive, are erasing memories, are erasing many cognitive functions.
Whereas aphasia is more just a glitch in some of the software. You know, word retrieval system or something.
Trevor: Would agree. . It's, the kind of language program.
People can have other types of. Speech problems, Dysphagia, which is slightly different from Aphasia, where the muscles in the throat are affected and therefore speech becomes more difficult, but that's affecting the hardware.
The language program is a software program. But you could also say whether it is damaged particular areas of the brain that deal with that
Rob: We should move on to the other major topic, well, the real reason for having this conversation, which has nothing to do with the brain or Alzheimer's or [00:16:00] aphasia.
Is of course, walking football which may be a bit of a surprise to you,
Trevor, but
Trevor: ha ha
Rob: You and John are both members of the Axminster walking football team that's how you met and so on by the way, is it, is, there's a rumor that Gareth Southgate came to see you and has adopted, having watched a walking football game, adopted these as tactics for the England in the early games of the Euros.
But that's probably not true. Do you want to take over, John,
Jon: This podcast is actually being sponsored by the Axminster Walking Football Club. So this is why we're talking about it.
I think the interesting thing about walking football is that it gives People of a certain age, over the age of 50 men and women, the opportunity to carry on and do a bit, a bit of exercise and try and play a game of football and, we're going back to mental health and maybe, Keep [00:17:00] their their brains ticking over as well and, with the social side of things.
Would you agree with that, Trevor?
Trevor: Oh yeah, definitely. Something like walking football. It's great, because you've got movement, you've got skill, activating old programs in your brain about, how to play football, a program that might have developed 60 years ago. And as you say, the social side.
Oxygenating your brain. You couldn't do anything more healthy apart from Scottish country dancing, which I believe there was some, there was some survey and that was like the healthiest thing you can do because you physically need to do activity. It's social, but you're also laughing a lot of the time.
Jon: Like walking football.
There's a lot of laughing going with the football. I've spoken to the club and they've said that they will sponsor this particular episode. In your honor, Trevor
Trevor: my goodness me.
Jon: You didn't see that
Trevor: I came to Axminster's I pulled my calf muscle.
Jon: I [00:18:00] know. I was there. You are, you're like Brian Robson, aren't you? You know, you mainly injured
Trevor: am mainly injured. Yeah,
it's just, it's it's, such a nuisance.
Jon: Right. That's, that's enough of that. Thanks for that. Back to you, Rob.
Rob: Thank you so much for, for coming and doing this, Trevor. It's, can I call you Trevor?
I've been calling you Dr. Powell. We had a debate yesterday. Do we call him Trevor, or do we call him Dr. Powell? Makes the podcast sound more important, you know, if we're talking to Dr. Powell, rather. Anyway, thank you so much for joining us and, and doing all this.
I ask this of everybody we interview. Is there anything you'd like to say about mental health or any other topic that we haven't covered?
Trevor: How to keep your brain healthy. You can boil it down to two or three bits of common sense. So first thing is keep your brain oxygenated . Do some [00:19:00] physical aerobic activity, whether it's walking or playing walking football or tennis or climbing mountains or doing the southwest coastal path, but do some physical activity if you get your heart rate up to a reasonably high level once or twice a week, that seems to be an effective way of clearing out all the fatty deposits in your blood that are the kind of things that lead people to having strokes.
So that's the first thing. Physical activity. Second thing, mental activity. There is a saying. You know, if you don't use it, you lose it. I'm in no doubt of that people that just retire, vegetate, watch TV, don't do physical activity, don't have a social life, don't do mental activity , the brain atrophies, it shrinks,
Rob: Is that literally what happens Does it actually shrink
Trevor: Yes, it actually shrinks. If you weigh a brain of a, eight year old [00:20:00] who's had dementia, the brain has shrunk inside the skull. And the areas where there is fluid are much greater. The kind of the fluid outside the brain and in the cavities of the brain, there's much more fluid than brain.
That's what happens to us all. So, you know, that's something to look forward to . So you can pick that up on an MRI scan or a CT scan.
You can see if someone's brain has started shrinking.
Jon: Thank you, Trevor, we'll go away and think about that one.
Trevor: Okay. Right.
