Thursday, 28 April 2022

contra aftab... again!

Awais Aftab and I have been having a discussion, via our respective blogs, about the intelligibility of certain notions in cognitive science. This stemmed from our opposing valuations of Anil Seth's book 'Being You'. Here's his latest post; below: my response.

Orbits and Explanations

What's an orbit, and what in a celestial system is properly said to orbit what? Well, take your pick:

i) What's properly said to orbit what (the sun orbits the earth, or the earth orbits the sun) depends purely on a decision as to what we set as our reference frame. (This was the 'geometric' conception I was working with before.) Pin the frame to the earth, and the sun will be doing the orbiting. Pin the sun, or go with Newton and pin the 'fixed stars' (imagine they exist), and we'll now have the earth doing the orbiting. (Note that, on this definition, talk of orbits just represents the distance and orientations of bodies: perfectly circular orbits are not here a different matter than two bodies rotating on their axes.) 

ii) What's orbited is always the centre of mass of a system of bodies, not any object in it. Thus the centre of mass of the solar system is - because the sun is so massive compared to planets and moons - fairly near the sun's centre. The sun wibbles its way around it without it ever moving outside the sun's circumference. The earth orbits this centre of mass from a greater distance; so it always 'goes round', if not 'orbits', the sun.

iii) What orbits what is given by a grammatical rule which says: when two bodies move around one another, the body which is most massive is that which is orbited.

iv) If the centre of mass in a system remains inside one of the objects, we say the object in question is what is orbited. (This is another grammatical rule.)

Now if I read him correctly, Aftab would reject i)-iv) and opt instead for: 

v) X is properly said to orbit Y if we have an explanation for X going round Y but not an explanation for Y going round X.

For Aftab, 'because Sun is extraordinarily more massive than Earth, it has a much larger gravitational pull'. And because of which has the much larger gravitational pull, we have 'a perfectly good explanation as to why Earth would move around the Sun' but not vice versa.

Now, Newton's third law tells us that forces between bodies are equal and opposite. So earth's gravitational pull on the sun is, one might think, as great as that of the sun on earth. And so I'm not entirely clear what Aftab means by saying that the pull of the earth on the sun is less than that of sun on earth. But perhaps we should distinguish between pull and force. Thus we might now say 'Because it's so much more massive, that same amount of force from the earth moves the sun but a little, whereas because it's so much less massive, the same amount of force moves the earth a lot'. And 'pull' we define in terms of the force's effects. (A big man readily pulls a little child along the ground and not vice versa, despite the fact that the forces in play between them are equal and opposite.) But the difficulty with this is that it simply begs the question we're trying to address. For why should we describe the effects in one way (the earth moves) rather than the other (the sun moves)? You can't here appeal to their movements in establishing which pulls which - well, not without a crippling circularity. (The example of the big man and the little child doesn't contradict this, for here we've involve a third body - the earth - which we've already established as our frame of reference.) The dilemma I see for Aftab here is simply: i) if you appeal to grammar to do the work of establishing which orbits which, then the appeal to explanation is redundant. ii) if however you leave room for explanation to do its alleged orbit-determining work, then you'll just end up begging the question as to what shall be counted as moving (and so as to what we shall count as orbited). My own proposal is that we instead just make clear which of senses i) - iv) we're using and leave matters there.


Aftab tells us that 'Gipps seems to think' that 'how do we perceive?' 'is not a meaningful question'. I'm a bit puzzled by that. After all, in both of my previous posts I said that it surely made good sense to enquire into the neurobiology and physiology of smell, hearing, sight, etc. Why can't that 'how?' question be used to prompt such enquiries?

Now I do happen to think - don't you too? - that we'd need to find out rather a lot more of what was puzzling the utterer of such words ('how do we perceive?') before we could be sure that anything we said would be meeting their need. (After all, word strings enjoy such meaning as they have only in particular contexts. 'How do we perceive?' does not, in and of itself, invite any particular enquiry; its sense is radically underdetermined.) But it's surely not hard to imagine contexts - I already adverted to some neurobiological contexts in my previous posts - into which a word string like 'how do we smell?' or 'how do we touch?' could be inserted and in which it could constitute a meaningful question. 

But perhaps here's the focus of our disagreement. There's a use of the 'how do we x?' question which asks which component actions we need to perform in order to succeed at action/task x. How did you plough the field? Well, I got the tractor out, filled it up with gas, attached the plough, lowered the plough into the earth, drove it over the field, etc. My thought is that, when you ask 'how do you x?' in that spirit, we're typically already at the end of the action line when we get to hearing, smelling, moving your finger, etc. At this point, other questions and other answers may find their place - for example, 'when you move your finger / smell the rose, what happens in your nose/brain/arm to make this possible?' Our interests will now typically be framed in physiological terms. Cognitive scientists, however, typically take there to be one or more intermediary levels of explanation here - levels that in some sense are still worth calling 'psychological' even if we're no longer talking about the actions of whole persons. It is about the viability of such levels that, I believe, Aftab and I are in disagreement. But, to be 100% clear about this: I'm not trying to rule out a priori that enquiries and explanations framed in cognitive scientific terms are possible. My method is different: it's to urge that those who posit such a level a) aren't clear about what they mean, and b) rather look as if they've got in an unwitting muddle. (The difference between 'you're talking nonsense!' and 'might you say what you mean, because so far as I can tell you're not using words in the normal way here?' should I hope be obvious by now.)


The terms in which Aftab articulates this intermediary level are 'information', 'inference', and 'prediction'. It's not, as he puts it, that the brain makes (Bayesian) inferences or predictions or processes information in the ordinary sense of those terms. Instead it does something analogous. So, what are these analogous senses? Seth didn't tell us in his book, and I've not yet found ready elucidations in the cognitive science literature. Now, Aftab doesn't tell us what it is for a brain to make something like an inference, but he does offer a suggestion as to what it might be for it to make something analogous to a prediction. This is predictive text on a phone.

If I understand Aftab right, then the idea is that the brain may be said to make predictions in the same sense that the phone makes predictions when we're texting. It's not that the brain predicts in the normal sense of 'predict', since otherwise we'd be in the peculiar business of trying to explain our ability to, say, make predictions in terms of our brain's ability to, er, make predictions - which would kinda be a non-starter. (It'd be like positing representations to explain how we see things - when the notion of a representation, if it's being used in anything like the ordinary sense, is clearly of something which itself needs to be seen. Or like explaining procedural knowledge in terms of the possession of theoretical knowledge which we'd have to know what to do with... etc. etc.) Instead, the brain 'predicts' in the sense of 'predict' that's in play when we talk of the phone predicting. Well, what is this sense, and is this a realistic suggestion?

Consider an online or paper dictionary: type in / look up 'arbo' and it will (let's imagine) show an alphabetical list like 'arboreal', 'arboriculture', 'arborization' ... etc. When we use predictive text, though, the order of words appearing on the screen isn't alphabetical, but instead depends on how often we've personally used them before (and how often we've used them after the previous word you've just written, etc. etc.). It's this difference - from a pre-programmed static order to a dynamically updated order - that gives our talk of the phone 'predicting' its sense.

I don't know that any particularly clear intuitions exist regarding what happens if this 'prediction' no longer displays. I mean: imagine that the problem is just with the output to the screen: might we say the phone is still predicting text? And at what point of failure in matching displayed word with intended word do we say that the phone is no longer predicting? Is it making bad predictions then, or just not predicting? And of course it's not that the phone knows what a word is, knows that you're typing on it, has any kind of orientation towards the future, can read or speak or write, has any genuine competencies, knows a language, can try or not try to do anything, etc. Speaking and writing - and ordinary predicting - are activities that go on for beings with a social form of life, and not only does the phone not enjoy sociality - it's not even alive. The phone has no praxis: it's not oriented to the truth; it's not engaged in intentional actions, since it has no ends other than those set by the programmer or those for which it's employed by the user; it doesn't actually follow or fail to follow rules - though we of course can describe its activity by using a rule (i.e. it behaves in accord with, rather than actually follows, rules); it only gets things 'wrong' or 'right' in an utterly derivative sense - i.e. in relation to our intentions to write this or that word; it can't think thoughts, and so the 'predictions' it makes aren't instances of thought; it understands (and misunderstands) nothing. But that's all fine of course. We don't mean that the phone is really making predictions in the normal sense. Predictions, after all, are actions, whereas all the phone (and, for that matter, the brain) has going on in it are instead (and as Aftab himself alludes to) happenings.

Now, Aftab says that what we have, when talking of predictive text, is nevertheless an analogical rather than metaphorical sense of 'predict', and that it's 'similar enough' to what we do when we think about what will happen and issue an actual prognostication. I confess I'm not quite sure what to make of this given both the myriad dissimilarities and the utterly derivative, artifactual, sense in which a phone 'predicts' anything. But perhaps the clue is in what Aftab also says: models of celestial bodies only make predictions of the planets' positions in a metaphorical sense, and to say of a pancreas that releases insulin (or whatever it does) in proportion to what's consumed rather than 'waiting' to detect blood sugar levels (I've no idea how it works; just imagine, ok!) is to indulge a 'pure metaphor'. In these situations there's 'nothing like prediction actually happening (as far as we know)'. .... But why is it that we say that the phone is doing something like predicting but that (my imagined) pancreas is not? Well, the only disanalogy I can see between them is that what the phone is involved with, even though of course it knows nothing of it (since it's not a knower), is semantic information or meaning. The marks on the phone's screen count as information because of how we relate to them, because of the place this artefact enjoys in our rich communicative, social, lives. 

The question still standing, now, is whether the brain could make predictions in something like this sense in which the phone predicts. And the issue I see with this suggestion is that there's an important sense in which we don't use our brains to think or smell. Now, sure, and of course, you'd have a hard job thinking or perceiving without a brain! And I don't mean to turn my face against idioms like 'use your brain for goodness sake!' That's not my point. What is my point is that the significance of the phone display really is a function of the phone having a role as an artefact within our discursive form of life. The significance derives from that use. The brain, however, has no such role. We can't see or hear or smell it or what's going on in it; we can't handle it; it's not a tool. It's part of us, an organ inside us, rather than something to which we, the 'whole us', stands in a meaning-conferring relation. Meaning is not conferred by us on our own brain activations: the activations are not used; they've merely a causal, rather than a meaningful, role in our normative practices.

In short, the relationship between brain stimulations and human psychological activity is quite unlike that between phone displays and human psychological activity.  (This, in effect, is precisely why the functionalist notion of 'brain as computer' failed all those years ago.) Whilst artefacts enjoy a derivative form of intentionality, organs don't. However we ought to articulate the relationship between events in my noggin and the thoughts I have, analogising with artefacts won't do it.


During his discussion Aftab suggests that 'maybe, just maybe' the brain makes something analogous to inferences about what is in the world around it. He doesn't delineate this analogous concept directly, instead choosing to focus on something he calls a 'physical' as opposed (presumably) to an ordinary, 'semantic', sense of 'information'. What is this 'information'? Information, in the sense in which, say, the brain can be said to process information, is present if the

state of a system at one point in time has a discernible relationship with the state of a system at any other time (e.g. you can use an equation to calculate the state of a system at one point given the state of the system at another point). In the case of perception, let's say I see a tree in front of me, and then I copy the shape of the tree on a piece of paper. We can think of this in terms of flow of 'information' -- there is a relationship between the physical state of the tree, the physical state of my brain, and the physical state of the piece of paper.

The 'system' here is presumably the tree-brain-paper system. To offer another example: the longer you leave a pizza in the oven, the less 'information' it eventually contains as to what toppings (vegetables, cheeses, microbes, etc.) were on it when you put it in. Information in this sense is, note, relative to what's discernible by some or other observer. (It may also be something like Shannon-information, another non-semantic kind of 'information' which cognitive scientists have said is relevant to the study of brain processes.) 

Now it seems very likely to me - despite Wittgenstein's Zettel §610 - that there'll be physical-information 'about' (i.e. reliably correlated traces of) the environment 'in' the brain. There's presumably no little mouse neurone that lights up whenever you see or smell a mouse, but there will be brain activation patterns which in some way or other map onto both the objects around one which are causally impacting on the senses and onto what perceivers take themselves to perceive. As Aftab rightly says it's the task of neuroscience to work out these relations between sensory stimulations and perceptual reports / perceptually-informed activity.

What I can't yet see, however, is that this notion of physical information is going to get us anywhere when it comes to making sense of what it is for a brain to (in some or other similar-to-our-normal-use-of-the-terms sense) make inferences or predictions. After all, what inferences in the ordinary sense have to do with precisely is information in the semantic sense. Yet here we're all agreeing that there's no ordinary, semantic, information in the brain.

This, then, is the difficulty I see for the cognitive scientific project as it's typically spelled out.  On the one hand it's urged that the brain is making predictions, inferences, etc., not in a metaphorical sense but in something like the literal sense. To support this it's pointed out that artefacts like computers and phones do after all make something like predictions, process information, etc. However then when it's pointed out that these artefacts are only said to engage in meaning-related activity in a derivative concessionary sense, because of the place we confer on them within our normative practices, and that the brain enjoys no such role - its role being instead its causal contribution to our capacity to engage in such practices - then notions of information etc which don't have to do with ordinary meaning are instead invoked. But the difficulty now is that causal operations on meaningless physical information look simply nothing like predictions and inferences in anything like their ordinary forms.

Wednesday, 13 April 2022

nota bene

I don't know about you, but the reason I often make notes after psychotherapy sessions is because I need aides-memoires. I've about 18 patients - in my private psychotherapy practice - at any one time; most of them attend just once a week. And sometimes they'll say something, or I'll think of something during or after the session, that I want to make sure I hold onto for later lest it should then prove relevant. ... Or they'll share the first name of their new girlfriend or pet tortoise or arch enemy, and I'll think it a good idea to jot that down since, truth be told, I'm not always very clever with names. ... What's more, I suffer from migraines, and these impact my memory formation and recall - so if I've a migraine I'll tend to write down a little more of what we talked about in the session. ... Occasionally I'll jot down something which, it seems to me after the session, is rather important - yet which keeps evading both my patient's, and my own, consciousness when we meet. And if, on a rare occasion, I feel I have to contact another professional - perhaps my patient is becoming psychotic or suicidal, say - I'll make a note of doing that too. ... Oh: early on in therapy I'll sometimes use the notes to sketch out a tentative 'formulation' - i.e. I sketch out something of my sense of what might be going on for the patient. This can, I think, help me organise my thoughts, although I confess I've not tried comparing times when I've written this out with times when I've not to see which came out best. (I mean, how could one even set about doing that in a scientific manner?) ... As well as documenting these things - which can take two or three sentences, yet may range between three words and a page of A5 - the only other things I ever document about my patients are: when they attend, whether I've invoiced them, whether they've paid - and of course I'll somewhere note their contact details.

These notes are locked in a drawer in my consulting room (which, naturally, is also locked). Nobody gets to see them except me. Or, well: I might on occasion share something in them with the patient - if, say, I've sketched a formulation in a diagrammatic manner. But really they'd not be of use to anyone else, including the patient, since what they're designed for, their whole purpose, is, as I said, to function as aide-memoires for me - and so they're replete with the requisite shorthand and clinical terminology to effectively support that end. 

Not only must nobody else ever look at them, since they contain information disclosed in the privacy of the consulting room, but nobody else even need be able to read or understand them - since, like I said, the sole function for which I make notes is to support the therapeutic process. Further, nobody pays me to write them: the patient pays for, and receives, the 50 minute sessions; what they take away with them is what obtains during the session. Yet it seems to me that making them occasionally, sometimes, supports the therapeutic process, and probably doesn't interfere with it too often (I don't think I get too fond of my own ideas in that way, and so am not too worried about overly-organising my thinking about the patient - although to be fair this may sometimes happen: the dangers of not 'eschewing memory or desire' as Bion had it are never too far away)... and so I make them.

Now all of that seems to me rather straightforward. And yet when we turn to the advice, instructions, rhetoric and rules of the bodies and bureaucracies which govern psychologists' practices, something rather different sometimes shows its face. The British Psychological Society - a professional body which no longer regulates psychologists' practice, but which many UK psychologists still belong to - tells us that the notes must only be 'of the highest standard required'. Given the actual requirements I have of my notes, that seems fair enough. But it then says that, even for private practitioners, these notes must be 'auditable', and must be 'accessible and useable by clients who have requested copies'. They should also 'serve their primary purpose...', which in my case I've documented above, ' recording the care of individuals through the work of the clinician.' The impression one rather gets is that it's somehow assumed that the reason why you make notes is to record what takes place in the sessions in a way that's auditable by others and accessible to the patient. Yet, well: why?! And what if that's not your reason?! I can report that ... wait a moment while I screw my 'reflective scientist practitioner' head on... this just makes little sense. As I'll shortly describe, what in psychology we call the 'primary' or 'work' task - the actual legitimate and legitimating point of the notes - here risks drifting from view, and something else seems to take its place. Oh, I forgot to note that, according to the BPS, both 'supervisees and supervisors should record information discussed in supervision.' And all notes 'should always be signed and dated'. (I can't imagine why I'd sign my notes, nor why I'd want to document all the 'information' my supervisees provide me with during supervision.)

Or take the Health and Care Professions Council's (...these guys actually do regulate practitioner psychologists these days...) instructions that 'you have a professional responsibility to keep full ['comprehensive'], clear ['comprehensible'] and accurate records for everyone you care for, treat or provide other services to.' Why? Well, the reasons given include to 'ensure service users receive appropriate treatment that is in their best interests' (I don't see how documenting the rubbish treatment you provide makes that treatment any less rubbish); 'meet legal requirements or respond to Freedom of Information or Subject Access Requests' (I don't see how you can comply better with FoI requests if your notes are fuller; in fact it'd be rather easier to comply if you had hardly any at all); and 'evidence your decision-making processes if later queried or investigated' (decision: to provide psychotherapy? to make a joke ten minutes into the session?). They do at least tell us that 'what records you need to keep, in what format and for how long, varies depending on the setting you are working in and the subject matter of those records.' So, good: there is that! But even so, what I understand to be the actual purpose of psychotherapy notes, and the reasons the HCPC offers for making them, rather seem to here be pulling apart one from the other. The spectre haunting these recommendations seems, to me, to be one of defensive practice, of documenting what's said and done in the clinic so that later you could justify yourself before another, or so that someone else could reconstruct what you said or did from these notes. And, again: this really isn't how notes function for a - or at least, for this - private psychotherapy practitioner. How many acts which are naturally and properly described as resulting from 'decision making processes' do you actually engage in, for example - other than that of taking on the patient for psychotherapy in the first place? Or, if we expand the grammar of 'decision' to include any intentional act such as a speech act, then how could anyone begin to note down the vast panoply of 'decisions' they make in any one session? (For what it's worth I'd submit that if you're engaging in decision processes properly so called, then you probably aren't actually engaging your self as the therapeutic tool, and so may not even be providing genuine psychotherapy in the first place. You're probably instead in something like an 'intervention'-providing business.)

Now perhaps we shouldn't make too much of the above-described recommendations. Maybe they're only really apt for institutional settings, for example, so can be safely ignored. (If so, it'd be helpful if the organisations in question would say as much, and acknowledge that a requirement for notes that are both comprehensive descriptions of session contents, and comprehensible-to-non-psychologists, is hardly going to be legitimate in much of the private practice context.) Furthermore, the Information Commissioner's Office (ICO) is explicit that records must only ever be 'limited to what is necessary in relation to the purposes for which they are processed' (this they call ‘data minimisation’). And my purpose in making my notes is, as I said, to help me hold in mind certain details from session to session, especially those which I'm likely to forget, lest they should later be relevant. To record anything else from the session rather risks going against the ICO's legal guidance, given the actual purposes I have.

Rather worse failures of fit between the actual clinical purpose of psychotherapy notes, and the kinds of expectations which outsiders seem to want to impose on them, can be found when we consider the legal context. Take, for example, the instructions provided by the aforementioned quango, the ICO, which organisation aims to implement the law contained in the data protection and freedom of information acts and regulations, the ambition being to 'uphold information rights in the public interest, promoting openness by public bodies and data privacy for individuals'. That all sounds good in principle (although psychologists of all people shouldn't underestimate the psychologically, socially, and economically toxic effects of bureaucratisation). We do, after all, want to make sure that we don't get rogue practitioners who fail to respect their patients by failing to keep their therapy notes utterly private. But when we look at their guidelines, what we soon find is something rather different. In particular we find a rhetoric of 'data' and of its 'processing' which, according to the definitions they give, makes 'data controllers' of private practitioners. 

And what is this 'processing'? Well, processing means, inter alia, 'collecting, recording, organising, storing, using, retrieving, altering, erasing, disclosing'. And 'data' means 'any detail [sic] about a living individual that can be used on its own, or with other data [sic!], to identify them.' (This rather reminds me of the hopeless Nazi answer to 'Q: What is a Jew? A: A Jew is someone whose grandmother is a Jew...' Or, for that matter, of the equally absurd: 'Q: What is a woman? A: A woman is someone who identifies as... a woman'.) One might think: phew, all this only applies to 'data' which is 'processed' on a computer... so my hand-written notes are exempt. But, no, even an email from a patient counts as 'data', and emails are obviously constituted and accessed electronically. Furthermore, if you plan to put your paper records 'on a computer (or other digital device)' or if you 'file them in an organised way' then they too count as 'data'. Here, I think, may be a relevant out: after all, can they really mean that if I just stuffed my patient notes in a jumbled sack, I'm not subject to the law in the way that someone who had each patient's notes in a singular file would be? In other words, perhaps 'organised way' here means something like: 'supports searches across records'. But well, who's to say? One thing is clear: the ICO website doesn't say what it means by 'organised'. (I suspect that 'organised' here means 'enables identification', so that it's here rather an empty concept.)

One might think: phew, the ICO only governs the activities of organisations, and being a 'sole trader' one is, by definition, not an organisation (since that term refers to an 'organised group of people with a particular purpose'). But no, the ICO (mis)use this term to 'include all data controllers, including sole traders'. So, well, fellow controllers, that's you and me.

OK, so let's imagine that I and my peripatetic violin-teaching friend (who communicates with her pupils by email to arrange sessions; has records of their addresses and session times; makes notes of what pieces and techniques they're practicing at the moment) are indeed data controllers. (A difference between she and I, though, is that as a psychologist I also 'process' 'special category [i.e. more personal, more sensitive] data' which is (in some way I confess I don't understand) more protected than ordinary data.) What of it? Well, the first thing to note is that, if one is indeed a fat controller, then one has to pay the ICO a fat fee of £40 a year. What's this fee for? What does one get for it? What do one's patients get for it? ... Well, all I'll say is that I could find nothing approaching an answer to these questions when browsing their extensive website. And what resources do they have for me, a psychologist, on their website? Well, type in 'psychologist', 'psychology' or 'psychotherapy' in their search function, and you get nothing back that's relevant to private practitioners. There's plenty of information there that might be useful to bona fide organisations that are in the business of actually, you know, collecting data. But nothing for the private psychological practitioner. Again, as with the suggestions and instructions from the BPS and HCPC, the problem here seems to be that the guidelines have not been constructed with the private practitioner therapist in mind. Given this I'd say it's questionable whether one should register with them. And yet, they nevertheless appear to command a near universal agreement from professional bodies that psychologists and other mental health professionals delivering psychotherapy in individual private practice should register with the ICO and pay the annual fee. (The BACP tells its members they should do both; the UKCP tells its members they should just do the latter.)

I want to say a little more about this 'data' that the ICO tells me I 'control'. So a patient may, during or after treatment, make the request to see their data or have it erased. Data, recall, include the information about when they attended, their contact details (... don't delete these before replying to the request...), the contents of the notes, etc. Now, one reason you might choose to document what you say and do in psychotherapy sessions has to do with a patient who later decides to sue you for bad treatment; you could then say 'well look, I did and said this, as I've written down here, and this is surely all well and good'. (I mean, if that's the way you roll, clinically, then, well, knock yourself out. I'll just note here that defensive practice of this sort may well come with psychological and professional costs which should not be underestimated - and which, it seems to me, may even impact the development of truly valuable psychotherapy relationships and thereby the work - and thereby be unethical from a clinical standpoint.) The ICO claims that you can refuse to comply with a data erasure request if you are establishing, exercising or defending legal claims. This doesn't specify whether you can keep it lest there be future such legal issues. However the example they then give is of a healthcare provider who they claim is legally proper to refuse a request to erase personal data from a previous patient because their liability insurance requires them to retain such records in case of complaints or legal claims. So it seems you can legitimately refuse to erase the 'data'.

It's also worth noting that, again according to the UK legislation, you must ask the patient's permission (see 6.1.a here) to 'process' any of this data. 'Processing', remember, includes writing and reading the notes. I submit that this could legitimately be taken to provide a reason to take the text of the law with a pinch of salt, and to question whether it really can meaningfully be said to apply to the clinical situation. Here we're in the bizarre situation of being advised both to take comprehensive notes but also to first ask the patient's permission - which they may of course withhold.

Here's an interesting thing about the ICO take on 'data': it tells us that 'personal data only includes information relating to natural persons who: can be identified or who are identifiable, directly from the information in question; or who can be indirectly identified from that information in combination with other information.' What that means, in fact, is that if you don't have your patient's actual identifying details (i.e. name, address, phone number etc.) on the notes, then the notes don't count as data. Why not? you ask. For surely, if I've got a page of identifying details, and we can work out who my notes refer to by cross-referencing with that page of details, then the notes count as data? Well, no, read it carefully: it says that, in order for the notes to count as data, you must be able to use them (by themselves or along with something else) to identify the person, not that you must be able to figure out who the notes refer to (by looking at the notes or looking at them in conjunction with something else). However I wonder whether the ICO isn't misrepresenting the law on this point. For what the regulations say is that 'personal data' means 'any information relating to an identified or identifiable natural person', and an 'identifiable natural person' is 'one who can be identified, directly or indirectly, in particular by reference to an identifier such as a name, an identification number, location data, an online identifier or to one or more factors specific to the physical, physiological, genetic, mental, economic, cultural or social identity of that natural person'. (I take it that 'identify' here means 'work out who the person actually is - i.e. which individual human animal we're talking about'. And that 'directly identified' here means 'identified in the information in question'. And that 'indirectly identified' means: 'by consulting some other information'. And that these EU-derived regulations are post-Brexit now a part of UK law.) There's still something missing in the law here; the phrase which contains  'information relating to an identified or identifiable natural person...' presumably ought to be filled out with '...who can be identified as the subject of this information'. But that's just a quibble and so, perhaps regrettably, clinical notes do after all seem to typically constitute 'data' since, except when they consist of clinical hypotheses (which, qua hypotheses, constitute information about the clinician's rather than the patient's mind), they consist of information about someone who can typically be identified as their subject. 

I want to end with an observation. Having talked with a lot of psychologists, psychotherapists and counsellors over the years, I've noticed that 'the notes' get caught up in a variety of superego-invoking, negative-transference-engaging, problematics of their own. They become the place where what one did and said is visible to an imagined judge (a judging figure, that is, not necessarily a member of the judiciary!), and so become fraught with issues of accountability. They become a locus of lost self-possession, and an attitude prevails in which one stops understanding that, to be a good psychologist, one must do one's spontaneous best, or stops understanding that we ought to model for the patient a form of self-acceptance in which one lives out of a trust that one is, in one's basic world-orientation, acceptable and valuable as a person, but instead thinks one ought to be 'following protocols' set down by some other psychologist or organisation. Now I know of no empirical data suggesting it's in any way better to engage in a hidebound litigation-wary practice. And since it rather stands to reason that it simply isn't better to engage one's patients thus - that it could in fact inculcate a counter-therapeutic 'anality' in the practitioner - I suggest it's an ethical duty to do otherwise. But the principle part of all of this that I want to stress takes us back to where I started: If you start to worry about your notes, and find that your mind is getting colonised by oppressive and debilitating shoulds and oughts around them, then first bring to mind their actual purpose. The purpose to which you actually put them in your clinic; the end to which you write them. Why you so much as make them when your making of them is guided by the clinical task rather than by a self-possession-sapping negative transference to psychological, governmental, and legal systems. The purpose in relation to the clinical task, that is, which task is, presumably, hopefully: the recovery and growth of the patient.