In recognition for the wonderful and far reaching influence on neurorehabilitation, Anne-Lise Christensen received the 2012 Lifetime Achievement Award from the International Brain Injury Association in Edinburgh Scotland. In her acceptance speech she shared the many important influences on her outstanding and legendary career in neuropsychology. We would like to share with you her thoughts and experiences that led to Anne-Lise’s extraordinary role in advancing our understanding and treatment of brain injury.
“I have been asked to give a short speech at the Gala Dinner where I am shown the great honor of receiving the IBIA Lifetime Achievement Award. To illustrate my gratefulness, I have decided to chart out for you the main events in my work, giving a picture of the twists and turns of my path and the tremendous thinkers and clinicians who have guided my way.
My lifelong preoccupation with the field of neuropsychology has a background in my studies at the University of Copenhagen. These studies began with philosophy courses and then progressed on to courses in Experimental and Gestalt Psychology. In lectures and group work on the phenomenology of human behaviour was a central focus. This was the main interest of the youngest professor teaching my peer group, Franz From. From described understanding the purpose of acts and interactions as essential for understanding human behavior, and understanding and interpreting intensions. This was much in line with the quotations from the Danish philosopher Soren Kierkegaard, which is of special interest to me:
“If one is to succeed in guiding a person from one state to another, one must first ensure that one can identify where the person is to be found and start there. This is the true secret of helping. All true helping begins with humility. The helper must first humble himself to the person that he wishes to assist and from this position understand that helping is not to dominate but to serve.”
The next strong influence in my education in psychology was Jerome Bruner’s lectures and small group seminars on cognition at Harvard during the semester 1953-1954. I became deeply interested in Bruner’s New Look Psychology which held that the perception of external stimuli is not free of the shackles of internal events, attitudes, values, expectancies and psychodynamic defenses, all of which impinge upon perception.
I began my clinical work back in Copenhagen, after graduation. My first appointment, in 1957, was at the University Psychiatric Hospital, where my task was to assist with diagnostics making use of the psychological tests available at the time: Intelligence tests (Binet), Kurt Goldstein’s neurological tests, and various psychodynamic tests, among them the Rorschach. While carrying out this work I became acutely aware that I lacked a great deal of neurological knowledge that was necessary to do the work I was asked to do effectively. This led me to seek out my next appointment in 1959, which lasted until 1970, in the neurosurgical University department. Here I was encouraged by an open-minded and supportive neurosurgeon, Richard Malmros, who wanted me to observe and assess patients before surgery, for example tumor operations, and to be present and informed by him about the procedure during the operations. It was then my task to complete follow-up in intensive care and thereafter as needed, a process that he was deeply interested in.
At this time there were very few published sources describing well-developed, integrated neuropsychological techniques. Therefore, when in 1966, Alexander Luria’s “Higher Cortical Functions in Man” was published, I experienced it as a godsend. I immediately tried the method described in my work with neurosurgical patients, which entailed not only gaining insight in the cognitive functioning of the patient being investigated, but also establishing a clear working relationship with that patient. Under the guidance of this method I learned to integrate clinical findings and insights into an integrated picture of the patient, which my medical colleagues regarded as more meaningful and enlightened overall.
The presence of Alexander Luria at the “World Congress in General Psychology”, held in London in 1969, was a matter of much apprehension but also excitement for me. At the reception initiating the meeting, I was pushed/encouraged by Jerome Bruner, who was a friend of Luria, to present myself and tell him about my work. Luria’s immediate reaction was: “Why don’t you come to Moscow!” However, the next day he had a heart attack, was hospitalized, and did not return to attend the Congress. His paper: “The Origin and Cerebral Organization of Man’s Conscious Action” was read by Hans Lucas Teuber.
At home, a few weeks later, I received an invitation from the Russian Ministry of Health to visit the Burden University Hospital, in Moscow. I left Denmark for Russia in 1970 with great expectancy and some trepidation.
I spent three weeks in Moscow during my first visit. In the mornings, I took part in rounds or in the investigations of patients. I was seated in an armchair next to Luria and was asked questions about what to do next! Afternoons were spent in lectures given by Luria in his home in Frunze Street. Occasionally, I was sent out with a guide to experience the Russian culture. It was all a very special highlight in my professional life!
Of course by far the most important aspect of this visit for me was the opportunity to learn from and observe Luria’s wisdom in action. By the time I left, I had gained critical insights into how to apply his highly sophisticated knowledge of neuropsychological functioning. His method of investigation allowed me to both evaluate the patient’s difficulties AND relate genuinely with the utmost respect to the patient in profound appreciation of his/her experience.
The last day, I showed Professor Luria the work my colleagues and I had done at the psychological department of the hospital. His comment was: “Of course, it is a vulgarization—but I have always wanted someone to do what you have done. So go home, translate the text into English, and come back and show me!”
I returned the next year and this time I was accompanied by my collaborators. Our work was met with acceptance. Luria gave us a text that he had prepared for the first chapter of “Luria’s Neuropsychological Investigation” along with the promise that he would write the forward.
“Luria’s Neuropsychological Investigation”, appeared in 1975. In the years thereafter, it was translated into eight languages.
During the seventies, I developed collaborations with many colleagues internationally: in Finalnd with Ritva Laksoonen and Anna Riita Putkonen, in the US with Edith Kaplan and Norman Geschwind in Boston, Donald Stein, then at Clarke University, George Prigatano, then in Oklahoma, and Yehuda Ben Yishay and Leonard Diller in New York. The new evaluation tool provided in “Luria’s Neuropsychological Investigation” for the assessment of brain function caused much interest at a time with the newly introduced views of brain plasticity, and new views of brain injury rehabilitation.
In Denmark, thanks to the visionary Egmont Foundation, the “Center for Neuropsychological Rehabilitation” (CRBI) was established in Copenhagen in 1985. I served as Director of the Centre from its opening until 1998. This exciting endeavor was “not without trials and tribulations” (as Donald Stein said), though it gave rise to many positive developments in brain injury rehabilitation in Denmark and possibly elsewhere.
In the years that followed, the founding of IBIA was a very important event for brain injury rehabilitation internationally. Since its beginnings IBIA has had a vital impact, and continues to do so today. At its regular Congress meetings 3000 participants from around the world share and discuss new knowledge in the field of brain injury rehabilitation. I was privileged to chair the first of these Congresses in Copenhagen in 1995.
Much has been gained in the field of brain injury rehabilitation over the past several decades, but there is still more to do. This is expressed as the aim of this Congress: “to provide an opportunity for establishing collegial relationships with international professionals focused on the care and/or service of persons with acquired brain injury research-to provide didactic opportunities for clinicians interested in advancing their knowledge in brain injury science, medicine and care”. It is a great credit to the brain injury field as a whole that it can now be said that brain injury is treatable and under the right conditions can be highly successful. Yet, with all that we have learned, it seems to me that continuing to identify and work towards these right conditions remains our ongoing challenge.
Finally, I’d like to say that my career and time spent in this exciting and extraordinary field has taken me on a marvelous journey that I hope is not quite over. I hope that my activities thus far have served people with brain injury, and helped to improve the future of neuropsychological rehabilitation. I would like to deeply thank the many collaborators and patients, who have inspired me in my efforts.
Last but not “least”, I would like to give my deep thanks to IBIA for this wonderful award.