Integration or marginalisation? Clinical psychology as a strategy for dealing with psychosocial issues in a South African neurosurgery ward

Abstract

Biomedicine has been criticised for its failure to take adequate account of psychosocial issues. One attempt to address this has been to employ clinical psychologists in general hospital wards. In order to examine this phenomenon, four cases referred to the first author while she was an intern clinical psychologist working in a Neurosurgery ward are reported and discussed. In addition, interviews were conducted with two clinical psychologists and the head of this Department of Neurosurgery. Issues that emerged from the data included evidence of referral of what could be more accurately termed social or structural problems rather than psychological problems; power imbalances between psychologists and neurosurgeons, and the elaboration of these factors within the particular context of South Africa. Taking account of psychosocial issues by employing clinical psychologists in medical settings may fail in that it may ironically facilitate the marginalisation of these issues, and allow social and political issues to be individualised and pathologised. Copyright © 1991, Wiley Blackwell. All rights reserved