The Psychologist September 2021 by The Psychologist

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psychologist september 2021

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psychologist september 2021

contact The British Psychological Society 48 Princess Road East Leicester LE1 7DR 0116 254 9568 info@bps.org.uk www.bps.org.uk the psychologist and research digest www.thepsychologist.org.uk www.bps.org.uk/digest www.jobsinpsychology.co.uk psychologist@bps.org.uk Twitter: @psychmag Download our iOS/Android apps advertising Reach 50,000+ psychologists at very reasonable rates. CPL, 1 Cambridge Technopark Newmarket Road Cambridge CB5 8PB contact Krishan Parmar 01223 378051 krishan.parmar@cpl.co.uk july/august 2021 issue 56,818 dispatched Cover From Getty Images

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issn 0952-8229 (print) 2398-1598 (online) © Copyright for all published material is held by the British Psychological Society unless speciﬁcally stated otherwise. As the Society is a party to the Copyright Licensing Agency (CLA) agreement, articles in The Psychologist may be copied by libraries and other organisations under the terms of their own CLA licences (www.cla.co.uk). Permission must be obtained for any other use beyond fair dealing authorised by copyright legislation. For further information about copyright and obtaining permissions, e-mail permissions@ bps.org.uk.

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The Psychologist is the magazine of The British Psychological Society It provides a forum for communication, discussion and controversy among all members of the Society, and aims to fulﬁl the main object of the Royal Charter, ‘to promote the advancement and diffusion of a knowledge of psychology pure and applied’

The Psychologist needs you! We rely on your submissions throughout the publication, and in return we help you to get your message across to a large and diverse audience. For details of all the available options, plus our policies and what to do if you feel these have not been followed, see www.thepsychologist.org.uk/contribute The main message, though, is simply to engage with us. Contact the editor Dr Jon Sutton on jon.sutton@bps.org.uk, or tweet us on @psychmag.

Managing Editor Jon Sutton Deputy Editor Annie Brookman-Byrne, Shaoni Bhattacharya (job share) Production Mike Thompson Journalist Ella Rhodes Editorial Assistant Debbie Gordon Research Digest Matthew Warren (Editor), Emily Reynolds, Emma Barratt, Emma Young

Associate Editors Articles Paul Curran, Michelle Hunter, Rebecca Knibb, Adrian Needs, Peter Olusoga, Paul Redford, Sophie Scott, Mark Wetherell, Jill Wilkinson History of Psychology Alison Torn Culture Kate Johnstone, Chrissie Fitch Books Emily Hutchinson Voices in Psychology Madeleine Pownall Psychologist and Digest Editorial Advisory Committee Richard Stephens (Chair), Kimberley Hill, Sue Holttum, Deborah Husbands, Miles Thomas, Layne Whittaker

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psychologist september 2021

Nick Ellwood/www.nickellwood.co.uk/

Letters From the President, and news from the AGM; social identity in poverty; aphorisms; statement from our advisory committee and more News BPS Conference 2021; strategy; PsyPAG; and much more Digest Play, and more

‘Sometimes the whole room morphs into a different place’ Lee Jones discusses Charles Bonnet syndrome with Keith Valentine and Judith Potts

Conversations on class Ella Rhodes and Annie Brookman-Byrne talk with psychologists about its impact

The justice system is failing victims and survivors of sexual violence Tammi Walker, Alison Foster, Rabiya Majeed-Ariss and Miranda Horvath with a response to the 2021 Rape Review

‘The person becomes the universe of exploration’ Astrid Coxon meets Honorary Fellow Jonathan A. Smith

Exploring novel approaches to youth mental health Lawrence Howells turns to health and emotion

Decolonising psychological science: encounters and cartographies of resistance Luis Gómez-Ordóñez and colleagues engage the decolonial project

‘With AI, we’re amplifying the powers of the clinician’ Ross Harper on his journey to CEO of Limbic, providing AI software for mental healthcare

‘Never feel conﬁned by methodologies or disciplines’ We meet Jovan Byford

Jobs in psychology

Books Intercultural competence; reviews; and we hear from Suzanne O’Sullivan about ‘the sleeping beauties’.…

Culture Including Black Future Dr, corneal donation, Another Round and more…

Forbidden histories Callum Cooper interviews Andreas Sommer

One on one… …with new President Katherine Carpenter

This month we welcome new Society President Katherine Carpenter. It has been, as Katherine says, ‘a very difficult year’ for the Society, and we plan more conversations with her on that over the coming year. Our advisory committee add some thoughts on p.5, and you can find mine in the online version. On p.80 Katherine picks out one aspect of the Society’s new Strategic Plan: Promotion and advocacy of diversity and inclusion within the discipline and practice of Psychology. ‘It would be fantastic if we could alter the perception some people have that the BPS is an old-fashioned, white, middle class organisation with little relevance for them,’ she says. We’ve certainly tried to do our bit in that regard over recent years, and continue to do so this month with ‘conversations on class’ (p.34) and other pieces. There’s plenty more in another packed and diverse issue, with online extras too. If some of it grabs your interest, please let us know… it makes all the difference, especially in a ‘very difficult year’… Dr Jon Sutton Managing Editor @psychmag

From our new President First of all I would like to thank everyone who voted for me. In fact I want to thank everyone who voted – because the role of President is a key one and needs a strong mandate. I’d also like to thank my fellow candidates, Carl Harris and Peter Branney, because I know they care as passionately as I do about the Psychology professions and getting things right. My vision is to get the Society back on track. It has lost its way somewhat, particularly in the last very difﬁcult year, and we need to get people talking and working together effectively again. I aim to deliver three things in the next 12 months. First, greater cohesion going forward. Second, I intend to get behind the important work that has already been started, particularly in the area of EDI and governance. And third, I want to increase the visibility of Psychology externally, and to increase the voice of Psychology in society. I want the BPS to be responsive, impactful, and relevant, so that the more newly qualiﬁed, undergraduates and the under-represented, all feel that it can be their home for the rest of their professional life. I realise that 12 months is a very short time, but I’m absolutely up for the challenge and I will do my very best to not let you down.

Katherine Carpenter is a Consultant Clinical Neuropsychologist, and has been elected President of the British Psychological Society 2021-2022. Revisit our 2019 interview with her via https://tinyurl.com/bpskatcarp and see also p.80. We expect to hear much more from Katherine over the coming months.

Assorted aphorisms and slogans

Over my 40 years as a social and applied psychologist at the University of Nottingham I built up a list of aphorisms (mostly) relating to psychology. Just a light-hearted piece, but perhaps a conversation-starter? • The essence of the natural sciences is taking things to bits to see what they are made of; the essence of psychology is piecing things together to see what they are part of. • Classical science teaches us that the whole derives its properties from the parts; but now we are increasingly dealing with phenomena where the parts derive their properties from the whole. • Experimental Psychology is to life, as chess is to war. • It is much better to understand what you don’t fully remember, than to remember what you don’t fully understand. (For exam purposes especially.) • The methods we typically use in research are designed to elicit from people the information we need for our purposes; not to provide them with the information they need for their purposes. • The scientiﬁc way to peel an onion is to start in the centre, and remove one layer at a time until you reach the outside. (This refers to the strategy in ‘hypothetico-deductive science’ of jumping imaginatively to the heart of what you want to discover, and then systematically working back, by logical inference, to the things that can be observed in order to check.) • A new PhD student has to learn to work various

important pieces of equipment effectively. One of them is called a supervisor. • Sometimes our narrow conception of scientific ‘rigour’ leaves us with nothing but problems we can’t solve on the one hand; and problems that are not worth solving on the other. • Hypothesis testing research can be focused on things you care about (although they may turn out to be untrue). Inductive, or data-driven, research picks out everything it can find that is true (although they may turn out to be things you don’t care about). • If I lived on a hill and wanted to see further, I would build a tower on the hill. I wouldn’t build my tower in the valley, and hope that one day it would be even taller than the hill. (What we know as scientists should be designed to complement what we know as ordinary people; not substitute for it.) • Planning your research career is about choosing a method, not choosing a problem. Choosing a method that is wrong (for you) means choosing the wrong life. Choosing a problem that is wrong just means you have some reading to catch up on. • I spent the first half of my career trying to make simple things seem complicated; and the second half trying to make complicated things seem simple. David Clarke Emeritus Professor University of Nottingham

the psychologist september 2021 letters

Other news from the AGM Nicky Hayes was announced the successful candidate for BPS President-Elect 2021-22, and will be President 2022-23. Christina Buxton was elected Honorary General Secretary. Dr Peter Branney was co-opted onto the Board of Trustees. Dr Jackie Greatorex was elected ordinary member of the Research Board. Dr Carole Allan and Professor Daryl O’Connor were elected Honorary Life Members of the BPS in recognition of their signiﬁcant contributions to the society. Professor Elizabeth Stokoe and Professor Stephen Reicher were made Honorary Fellows of the BPS in recognition of their signiﬁcant contributions to psychology. The Special Group in Coaching Psychology was re-designated to a new Division of Coaching Psychology. Prior to the AGM, Professor Andy Tolmie was appointed the new Chair of the Research Board, and Professor Niamh Stack was appointed Chair of the Board of Education and Training.

President-Elect Nicky Hayes

Honorary General Secretary Christina Buxton

Can empathy training increase empathy? When empathetic people detect suffering, it is hypothesised, they feel compassion and an urge to help; when people don’t feel compassion in response to suffering, they are said to lack empathy. This has led to training courses designed to increase empathy. Although not everyone sees empathy in this simple, positive way (see Diana Kwon’s 2017 review article in The Psychologist, for example), the view that more empathy is a ‘good thing’ is widely held. And yet, the conceptual premises underpinning this empathy-positive viewpoint remain untested. How do we know that empathy is quantiﬁable, normally distributed and amenable to increase? Although researchers in empathy often talk about empathy triggering ‘appropriate emotions’ who decided what ‘appropriate’ means? And why is empathy research focused entirely on suffering? What is an ‘appropriate’ response to, say, joy or anger? It’s conceptually messy. And in an article published at https://thepsychologist.bps.org.uk/empathy-trainingvaluable-enterprise-or-basic-misunderstanding, I argue that the only way to resolve the conceptual discrepancies is to replace ‘empathy’ with ‘empathetic perception’. Empathetic perception, like visual perception, is universal, reﬂexive – and ‘hungry’. We detect emotions everywhere: in our gods, cars, pets and nation states (sometimes with shockingly violent outcomes). But while detecting emotions might be innate, our responses to other people’s emotions are nearly always learned individually or socially.

So where does this leave empathy training courses? They provide useful social skills coaching and better awareness of prevailing social values. They teach trainees how to appear compassionate and even behave more compassionately. But the claim that they enable trainees to feel more compassion remains unproven. If empathy is better thought of as empathetic perception (a sensory processes rather than a mechanism intended to make us behave compassionately), how does it work? Visual perception offers an apposite comparator. We all have an innate blueprint for visual perception. But where we focus our visual perceptions is determined by learning. In a landscape, some people notice (and even respond emotionally) to the mountains; others to the trees – all depending on their learned interests/ prejudices. Empathetic perception is similar. Our detection of emotions (from joy to suffering) is reﬂexive, but our emotional and behavioural responses have to be learned. Sometimes that learned emotional response will be compassion. But, equally, it could be jealousy, rage or schadenfreude. And that is where empathy training courses come in. They cannot increase empathetic perception, but they can teach us to respond to more compassionately. Dr Chris Timms Independent writer chris.timms54@gmail.com

Social identity in poverty

www.thepsychologist.org.uk

Tim Sanders

From poverty to flourishing

I thoroughly enjoyed reading the articles from David Robson and Jennifer SheehySkeffington in the July/August edition. The analyses of factors influencing the choices people make when in poverty help to clarify underlying aspects of the lived experience of poverty that many decision makers in services simply have not got their heads around. How personal agency is dominated by the stress of the tensions posed by what their money should be spent on is evident and for me goes back to some very rudimentary elements of self and identity. While being a relatively older perspective I still find that self-concept and how it interacts with the more recent formulation of an individual’s social identity has power as a basis for understanding the behavioural choices made by those in poverty. At different times in my very varied working life I was aware of the dilemmas faced by many people with little income. In retirement I was a ‘debt adviser’ for a while, and directly saw how the sense of self and identity impacted the decision making process and choices made. For example, buying a large screen TV makes a statement about your access to high value goods even if the choice makes another part of life more difficult. In another situation the need to be part of a family where many Christmas presents were exchanged conflicted with a young couple’s deep desire to find a way into a life without the challenge of indebtedness. Yet their self-concepts struggled to internalise a sense of personal behaviour that could surmount familial ties, their rationale being ‘That is how it is in our families, it’s what we are, what we do’. They chose to remain in significant debt. Most of us will experience stress and how it can freeze the capacity to think clearly. For those with limited psychological and emotional resources in poverty the clearest route out of the conflict inherent in such choices and decisions was, I noted, reflected

in a strong tendency for the ‘pull’ of being viewed as part of a group or community, however this might be deﬁned by the individuals themselves. This comes as a result from that want to align self-perception with an identity as an accepted part of a group or society. This is a tension between acting in your own best interests versus behaving according to what you are interested in. The desire to be seen as of ‘worth’ somehow and to feel part of the ordinary community becomes an attraction to prefer what best serves their perceived interests in maintaining a certain social identity and personal selfconcept despite the risks of indebtedness. Jim Wood Retired Educational Psychologist, Ottery St Mary, Devon

More letters online at www.thepsychologist.org.uk/debates, including: Christian Pszyk on Emotional Periodisation at the Olympics Dane McCarrick on football’s home advantage and the pandemic Gilbert Christie 1943–2020 A tribute from his wife Sharon, daughter Jacqueline and son, James Albert Bandura 1925-2021 We were sad to hear of the death of this giant of Psychology and past contributor, and expect to run an obituary soon.

Gilbert Christie

Deadline for letters for the October print edition is Friday 27 August 2021. Email letters to psychologist@bps.org.uk with the subject line ‘Letter to the editor’.

the psychologist september 2021 letters

At the coal face For decades the Community Mental Health Team in localities throughout the UK has been known as ‘the coal face of mental health’. Like the shutting of the pits in the 80s our CMHTs are under threat from NHS England’s New Community Mental Health Framework (see https:// tinyurl.com/hpcu7ux4). It is the latest instantiation of neoliberalism within the NHS that promotes a market driven and industrialised approach to mental health care. The Framework emphasises the outcome-based values within primary care IAPT services, primarily, returning people to work. Whilst it may better integrate primary and secondary care, this seems to be to the detriment of complexity and depth of working. The

work of the psychologist in CMHTs is mostly providing individualised assessment, formulation care and treatment for individuals who have been at the extremes of human distress. Whilst the Framework is said to provide pathways for specialist services, accessing any is difﬁcult with exclusions and gateways on never ending pathways through diversion schemes and call centres such as Single Points of Access. Not to mention huge waiting times. Increasingly, psychologists and psychotherapists working in CMHTs are being drawn away from their individual therapy that values the basic idea that emotional and mental distress can be helped by talking. Instead, they may be overseeing suboptimal ‘interventions’ where

unqualiﬁed staff such as support time recovery workers offer basic behavioural activation sessions. I argue that these outcome-based approaches create the very distress and depression that therapy in CMHTs has long been valued for healing. Having worked in CMHTs for 23 years, I have seen many incarnations and operational models come and go. However, this is a threat to the core of what psychologists and psychotherapists do well. Talking therapy from CBT to Psychoanalysis should be fuelling CMHTs and not allowed to become a dying ember. Tom Elliot CPsychol AFBPsS Margate, Kent

From the Psychologist and Digest Editorial Advisory Committee Ever since The Psychologist emerged from the Bulletin of the British Psychological Society in 1988, there has been an editorial advisory committee of members charged with regularly assessing the magazine’s performance against its published policies and procedures. Discussions within the committee, and beyond with both Society trustees and management, have often considered the role of The Psychologist as a Society publication reporting on the Society itself. Recently, members again requested such consideration from the committee, and this was given a full airing at our June meeting. The committee comprises people from a range of ethnic, cultural, and psychology backgrounds, so our discussions include diverse viewpoints. The members present were in clear agreement that it has been a turbulent year for the British Psychological Society, often with a lack of regular communication and leadership from the centre. We care deeply about our professional membership body, and an information vacuum will always be a concern – particularly if that vacuum is ﬁlled by sources ranging from national press to personal blogs, and we have no way of assessing how reliable they are or keeping up with them all as we lack direct access to all the information. However, the committee also recognise challenges inherent to The Psychologist’s role in communications around the Society. Some areas – particularly those around Society outputs grounded in psychological theory, research and practice – have and always will be covered, even if controversial. Some involve ongoing legal and / or personnel issues where it is not possible or appropriate for a Society publication to comment, as the Society has a duty of care to

its employees. Some are governance issues where The Psychologist has reported and will continue to do so, as part of a wider Society comms effort. In discussing specific examples of what has and has not been included in the magazine over the past year or so, the committee were satisfied that the editor’s independence has been maintained – the magazine is not being silenced. There was a reminder that the magazine has always prioritised member voices, so constructive contributions are encouraged; and as soon as new leadership is in place, those individuals will be encouraged to have a presence and voice in the magazine to focus on how the Society can now move forward. In closing, it’s worth noting that these communication issues were discussed at length, and we struggled to come to obvious ‘solutions’. The conversations will continue. The Psychologist means many very different things to many very different people. We are clear that it is a magazine, for a large and international audience that reaches well beyond the Society membership. The editorial team have always had a challenge on their hands meeting expectations month after month, and now day after day, often in an increasingly polarised online world. They have our full support in that, and we will continue to frame that support within our shared values of openness, transparency, accuracy and respect for individuals who work in the organisation. Dr Richard Stephens, Chair, on behalf of the Psychologist and Digest Editorial Advisory Committee. r.stephens@keele.ac.uk Find reflections from the Managing Editor in the online version.

what to seek out on the

psychologist website this month

‘You explore your entire being’ Richy Bennett is a performance psychologist who has worked with the Australian Paralympic Team. Debbie Gordon asked him about surfing and also heard from Dr Nick Caddick about his work with veterans The psychology of friends Archive with insights into why friendship matters and how we can connect safely during the pandemic I can be successful An edited extract from Dr Josephine Perry’s book I Can: The Teenage Athlete’s Guide to Mental Fitness Safeguarding in research – expect the unexpected Emma Brooks and colleagues share experiences working on a NIHR funded study called identifying Child Anxiety Through Schools (iCATS) Find all this and so much more via

thepsychologist.bps.org.uk 06

the psychologist september 2021 news

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Should social class be a protected characteristic? Ella Rhodes with the ﬁrst in our selection of reports from BPS Conference 2021, held online 1-2 July

sychologists and experts in health policy and law came together to discuss whether class should be included in the Equalities Act – hosted by Dr Nasreen Fazal-Short, Chair of the British Psychological Society’s Presidential Taskforce on Diversity and Inclusion. In his research senior lecturer and social psychologist Dr Matthew Easterbrook (University of Sussex) explores how our social identities can help to explain educational inequality. He agreed that class should be included in the act and pointed to the additional barriers for people from working class backgrounds. ‘Sometimes pay is less for working class people… for equivalent jobs, some professions are virtually off limits to people from working class backgrounds. Four per cent of doctors say they are from working class backgrounds – if you’re a working class person going into the medical profession that’s a pretty clear message that that’s going to be a very hard task.’ Easterbrook said that working class people also feel a great deal of stigma; like they do not ﬁt in, and are generally under-represented in middle class worlds and professions. He said that including social class in the

Equality Act would be a recognition of the inequalities that exist for working class people, and would legitimise positive action which aimed to reduce social class inequalities. Head of Psychology Dr Bridgette Rickett (Leeds Beckett University) said that as well as reiterating the arguments for the Equality Act to protect class-based inequalities she also wanted to implore psychologists to attend more to class. She said that a general view in psychology research of working class people being deﬁcient in some way had led to discriminatory practices being supported within research. Rickett added that career pathways in professional psychology were almost impossible for many working class people to embark on, and that these pathways are based on middle class ideals – for example assuming a person would have external ﬁnancial support or would be willing and able to leave their support networks in their local communities. Rickett said there was a well-established link between economic inequalities and psychological distress. ‘This is important for policy… we know that equality and social justice and social cohesion in our communities and our society

the psychologist september 2021 news bolsters better psychological wellness. For psychologists these are the many reasons why this should be of interest to us.’ Qualified barrister, campaigning journalist, and codirector of Compassion in Politics Jennifer Nadel said unfair socio-economic structures affected life expectancy, psychological wellbeing, physical health and educational attainment. She said it would be a great thing to include social class in the Equality Act but that definitions could be a barrier to this – many different definitions of class exist and many do not take aspects such as selfidentification into account. ‘At Compassion in Politics we’re very supportive of this idea but we’re probably more supportive of a different part of the Equality Act which is section one – which would basically enshrine socio economic rights as a fundamental human right, and it would place an obligation on most public bodies to prioritise getting rid of inequality. We would argue that getting rid of inequality and having targets and being obliged to address inequality is probably the most pressing need. It’s there on the statute… It doesn’t need to be drawn up, it’s there, it just needs to be enacted, and versions of it have been enacted in Scotland and Wales.’ Senior Fellow in Health Policy at the Nuffield Trust, Dr William Palmer, has recently been involved with work for the BPS on psychology graduates’ career paths (tinyurl. com/kprvbnht). While there is a diverse range of people studying psychology, he said this range is not balanced – proportionately more white people study psychology at undergraduate level than medicine, sociology and nursing. Palmer said progressing through to a career in psychology was a long road and said there were several issues worth highlighting. ‘Nearly two thirds of entry level positions for psychology typically list previous experience, which might prohibit certain people with certain backgrounds who don’t have those opportunities to gain those experiences.’ Palmer also examined the career paths of people from the lowest socio-economic quintile compared to the highest. ‘People from the lowest socio-economic quintile are half as likely to apply to study psychology and once you’re there it’s 1.4 times the likelihood of not completing your degree.’ People from the lowest socio-economic quintile are also less than half as likely to be successful when applying to postgraduate clinical psychology courses. ‘Throughout this career pathway we see issues for those from lower socio-economic groups in terms of their ability to participate in psychology, education, training, and then in careers.’ Fazal-Short asked the panel why the Equality Act does not already protect social class, and what some of the barriers may be to its inclusion. Rickett suggested that notions of class had been disintegrated, and that the British were particularly bad at discussing class – adding that the idea we hear of a classless society may lead to a feeling that we do not need to protect it. The interaction between social class, race, and other

characteristics, also came up for discussion. Easterbrook said that identities did interact, and that different groups faced different realities, stigma and threats, but the data in this area were poor – for example while some ethnic groups have higher levels of exclusions there is little known about any interaction with gender or social class. ‘Whenever there’s a discussion about social class or ethnicity we need to try to ensure that this incorporates other intersecting identities within that so that the data start to be routinely collected so we can understand it better.’ Nadal said that this conversation had been politically hijacked recently by those with a deﬁnite rightwing agenda. ‘The [Commission on Race and Ethnic Disparities] education report that came out recently which highlighted the plight of white working class males, could have chosen all sorts of different sets of data… which would have focused on ethnicity… but it chose not to. And so we have to be really vigilant and on guard and be able to argue with the facts that are there… it was really disingenuous and very damaging report.’

The right track… for some A new Nuffield Trust report ‘The right track’, commissioned and supported by the BPS and written by William Palmer, Laura Schlepper, Nina Hemmings and Nadia Crellin, explores the career routes of psychologists. Although data on the socioeconomic status of psychology students and graduates is not always complete, and varies between different psychology careers, the report uncovers some interesting relationships between socioeconomic status and psychology education and careers. • Those who come from areas which have the highest rates of higher education participation have an attrition rate at Psychology undergraduate level of 3.4 per cent compared with 4.7 per cent of those from areas with the lowest participation in higher education. • There were twice as many applications to psychology undergraduate degrees from people living in the fifth of local areas with the highest youth participation in higher education, compared with those in the fifth of areas with the lowest participation. • People with the lowest socioeconomic status are less likely to apply to clinical psychology doctorates, and those who do are less likely to be accepted onto courses. • The authors pointed out that around 63 per cent of entry-level positions require previous experience – which could stand in the way of people from lower socioeconomic backgrounds entering these roles. • It also pointed to research by the National Collaborating Centre for Mental Health which highlighted that honorary assistant psychology posts, and a practice of keeping assistant psychology vacancies open for less than a day, may exclude those who do not have family support and be ‘opportunistic for those with time to job search’. • The authors also suggested that, while it has been previously established that there are fewer applications to clinical psychology from lower socioeconomic groups, this rate could be even lower for areas including counselling or health psychology, where postgraduate qualifications are required and are often self-funded. Read the report at tinyurl.com/nuffbps

A symptom of a culture of stigma

Rethinking Psychology in the digital age The opening talk in this year’s student stream of the annual conference was from Dr Amy Orben (University of Cambridge). Opening with a historical perspective, Orben noted technology-related concerns stretching back to radio use in the 1940s and its addictive nature. She explained that panic around technology appears cyclical, and that the development of each new technology appears to replace others over time. An industry has sprung up around moral panic over technological advances, including countless research studies looking at video games through a lens of increased aggression and the possibility for addiction. Orben explained how technologies appear to be repeatedly linked to complicated changes within society, and we are quick to connect the two – for example, the use of smartphones and a reduction in mental health. That’s why a historical perspective can help put things in perspective. When reflecting on now and then, Orben did point to the highly individualised and algorithmically determined technologies of today. Their use is more time intensive and spilling over into more areas of our lives, such as health care and education. Presenting her research around the link between digital technology and well-being in adolescents, Orben showed that specification curve analysis on a large set of cross-sectional data revealed a small negative correlation. She discussed the importance of understanding effect sizes – although small, this may be impactful on a worldwide scale. Understanding correlation and causation is also vital. The default argument is that social media use leads to a reduction of mental health, but that relationship could be reversed, or there could be other driving factors. Orben also stressed that understanding the impact of social media on the adolescent population is complicated due to the vast number of individual differences between people. The field has also not done enough to study diversity, she said. A point I took away from the talk is that psychology cannot treat every technology that emerges as ‘new’. This has caused a disregard of previous literature, with research restarting every decade or so. Too much time has been spent on questions that are relevant to only a minority of the population. Orben concluded by stressing the importance of an overarching theory to help us progress, as opposed to being guided by the latest societal problem. That’s going to involve resources and expertise from right across the discipline. ‘We urgently need better-quality data,’ she added, ‘including communication with big technology companies for data access’. ALICE SIMS, BPS STUDENT COMMITTEE 10

‘conversion therapy’ is not a specific therapy and although it may be carried out by psychologists, it is practised widely by others including religious groups. Conversion therapy should be placed within a broader agenda in psychology to enhance LGBT+ wellbeing, Jowett argued. He noted that: ‘It’s currently all too easy to go through one’s psychological education and never cover these topics.’ Conversion therapy has not been standard practice for over half a century, he said. Homosexuality was removed from the DSM in 1973 and has not been listed as a mental disorder by the World Health Organization (WHO) since 1990. Being transgender is no longer listed as a mental disorder in the WHO’s International Classification of Diseases (ICD). ‘Diversity in sexuality is considered part of normal human variation,’ said Dr Jowett, Associate Head of the School of Psychological, Social and Behavioural Sciences at Coventry University, who is leading research for the Government’s Equalities Office. Yet in the 2018 National LGBT Survey of 108,000 LGBT+ people in 2017, nearly 7 per cent had either undergone or been offered conversion therapy. Some 2000 people across age groups had undergone conversion therapy in the UK. There was wide variation in who was offered or underwent conversion therapy – with trans people, those of faith, and those from ethnic minorities disproportionately affected. ‘This appears to be an intersectional issue,’ he said. Conversion therapy is a source of minority stress, he added, because it actively stigmatises LGBT+ people – perpetuating negative stereotypes and exacerbating internal conflict. It can also cut people off from sources of support such as LGBT+ groups. Psychology has a ‘troublesome past’ and legacy of ‘historically pathologising sexual and gender diversity’, said Dr Jowett. He said that BPS journals published pathologising studies up until the late 1970s, based on his literature review published in the Psychology of Sexualities Section last year. Banning conversion therapy alone will not ensure the safety and wellbeing of LGBT+ people, urged Dr Jowett. ‘We need to see conversion therapy as part of a bigger problem. It’s a symptom of a culture of stigma.’ SB

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‘Some of you might be shocked that this is still happening in the UK in 2021 – and not without good reason.’ With this, Dr Adam Jowett, Chair of the BPS Psychology of Sexualities Section, dived into his talk for the student stream on conversion therapy in the UK. The UK government is currently bringing forward a bill to ban the harmful practice, which refers to attempts to change somebody from being gay or bisexual to being heterosexual, or to ‘try to convert them from being transgender to identify with the gender they were assigned at birth. Jowett was careful to make clear that

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Getting through a potentially traumatic event We know many of the correlates of resilience, but we still can’t predict who will be resilient to potentially traumatic events with much accuracy. That’s the ‘resilience paradox’, and Professor George Bonanno (Teachers College, Columbia University) has a solution. Speaking in the ﬁnal keynote, he said it had been staring him in the face for a long time. Bonanno has spent his career trying to understand the diversity of responses and trajectories following a potentially traumatic event. Following events such as a mass shooting, spousal loss, or spinal cord injury, about two thirds of people show resilience – a stable trajectory of healthy functioning. Multiple unique predictors, including personality, social support, and economic resources, each have a small effect on whether someone is resilient. There are no known big factors, and even when all of these small factors are taken into Derek Hudson/Getty Images

The siege of Sarajevo (1994)

account, most of the puzzle remains unexplained. With Charles Burton, Bonanno has argued that it is a fallacy to see a trait as either adaptive or maladaptive. In practice, different situations present different challenges. A behaviour that is adaptive in one context on one day isn’t necessarily so in another context or on a different day. Bonanno now thinks it’s obvious that there is a complex and dynamic interplay of those predictors, rather than categories of good and bad traits or strategies. Psychological or regulatory ﬂexibility is about working out what’s happening, what we can do, what we should do, selecting a response, and monitoring it. Bonanno deliberately calls events ‘potentially’ traumatic – it all depends on this complex interplay. Similarly, although we think of people as resilient, they are potentially resilient, he said, because they may hold some characteristics that make them slightly more likely to be resilient in a given scenario. Bonanno believes that efforts to build resilience probably won’t work because they’re based on increasing very small effects. Instead, understanding psychological ﬂexibility as a mechanism for coping with potentially traumatic events can encourage us to use whatever tools we have, including what he calls ‘coping ugly’ – using a strategy you rarely use or is unhealthy but gets you through the situation. ‘You use what you have at your disposal when it’s the right thing to do.’ ABB

More news online at www.thepsychologist.org.uk/reports, including: Psychologically Informed Collaborative Conversations for patients in pain: we hear from Dr Anna Mathieson about a new approach. Professor Angel Chater on her work with Team GB to keep athletes safe during the Olympics. Professor Martin Milton reports from the Division of Counselling Psychology’s Annual Conference climate change strand.

Outspoken advocate for wellbeing The plenary keynote closing day one was from Professor Carol Ryff (University of Wisconsin-Madison). Again there was a Covid tinge to her question, ‘Is wellbeing beyond the reach of many in our contemporary societies?’ According to her six-factor model of psychological well-being, key to achieving Aristotle’s ‘activity of the soul in accord with virtue’, achieving ‘eudamonia’ or ‘the best that is within us’, is autonomy (marching to one’s own drummer), environmental mastery (managing your external world), personal growth (making the most of your talents and capacities), positive relations with others (taking care of your social ties), and purpose (finding meaning and direction in your life). Her assessment instruments have been translated worldwide and fed into thousands of publications, including intervention studies. Why so much interest? ‘These are intellectually vital ideas and ideals’, Ryff said, ‘reaching for the essential meanings of what constitutes the best within us. It’s scientifically relevant and versatile, and embraces integrative science.’ That includes genetic studies, and ‘wellbeing therapy’ rolled out across the lifespan. But recent years have seen obstacles to wellbeing – everwidening inequality, a great recession, Covid-19. ‘These are intersecting catastrophes,’ Ryff said, pointing us to Richard Reeves’ Dream Hoarders on ‘how the American upper middle class is leaving everyone else in the dust’. Ryff pointed to ‘monopsony power’ – how corporations suppress wages below an efficient or perfectly competitive level of compensation – as a ‘behavioural enactment of corporate greed’. Despite gains in educational attainment over time, post-recession samples have lower incomes, wellbeing and health, and Covid has only ‘exposed and exacerbated pre-existing inequalities’. ‘We need to rethink practice and interventions,’ Ryff argued. ‘How do we help people facing structural problems? How do we have a presence in public policy?’ Ryff also suggested that the arts can foster insight and compassion about injustice and inequality, pointing to sources ranging from Dickens Tale of Two Cities to modern films such as Parasite and Nomadland.

With the audience questions that followed, it was interesting to hear Ryff addressing a recurring theme from our own pages in candid fashion. ‘I believe value free science is a joke, is ridiculous,’ she said. ‘Science that has no value foundation is deeply problematic. I encourage all I mentor to identify questions in line with their values.’ We’re only going to have an impact at the highest levels

of policy, Ryff added, ‘if we’re outspoken advocates’. That can take ‘a fair amount of courage’, she admitted. ‘People were discouraging me from doing this research. The National Institute of Mental Health said “we don’t fund research on wellbeing”. I told them “Then you should be the National Institute of Mental Illness”.’ JS

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What’s it like to advise government in times of covid? We heard direct from some of the voices who have featured so prominently on the airwaves and in our newspapers over the course of the pandemic. Professor John Drury (University of Sussex) took us through the process for early contributions of SPI-B, one of a number of subgroups that feeds into SAGE. Published reports were initially heavily redacted, i.e. ‘not taking the behavioural science advice that transparency was vital to winning trust’. Professor Stephen Reicher (University of St Andrews) gave numerous examples of ‘false and counterproductive assumptions about the public’, and the ‘terrible mistakes’ made as a result of those assumptions. Research going right back to the impact of bombing on morale in World War Two has shown connection and solidarity in the face of major events, and a general attitude that is ‘remarkably steady and restrained’. We need to ‘listen to the public, treat them as an asset not a problem,’ Reicher said, and recognise that ‘resilience is a property of what happens between individuals’. So how do we get the ‘right psychology’ – admittedly crudely defined, Reicher said – to the right places. A Chief Psychological Officer? ‘I do believe it’s worth working inside government,’ Reicher said. ‘But behaviour is not a matter of psychology alone. The judgement of how important consequences are is a political decision, and we shouldn’t pretend it’s a scientific one. We should perhaps replace “follow the science” with “listen to science”.’ Professor Ann John, of Swansea University and a member of the government’s Technical Advisory Group, echoed the idea that advice is taken by policy makers into a wider context. And ‘size matters’ in terms of that context: relationships in Wales had been, she said, much closer. There has been a ‘real step change in the understanding of the importance of behavioural science’, and ‘trust in government in Wales has been consistently high’. Governments can legitimately hold and implement different views, John said, but there’s always the risk that variable restrictions may generate a sense of unfairness, potentially undermining adherence to rules. Professor Susan Michie (UCL), who set up SPI-B as a subgroup of SAGE back in 2009 in response to the swine flu pandemic, said it’s ‘great that it’s survived and increased in terms of diversity’. She opened with Philip Ball’s comments in The Guardian, that ‘scientists should not passively resign themselves to the “on tap” status assigned to them by Winston Churchill’. Michie admits a tension here: ‘On the one hand we are not

‘Listen to the public, treat them as an asset not a problem’ elected officials, and are often unfamiliar with the policy context. But on the other, evidence doesn’t implement itself; policymakers often don’t understand the scientific advice nor how best to translate it; translation and implementation are themselves the subject of scientific enquiry. Shouldn’t social scientists be asked to advise on the translation process itself? Shouldn’t scientists work in partnership with policy makers?’ Whereas others like Sir Mark Walport have emphasised throughout the pandemic that ‘scientists advise, but politicians decide’, Michie clearly feels that scientists should also consider whether a policy is deliverable, and what might be the consequences. There’s even a role for considering how the policy fits with personal and political values, she said. Psychology is not just about what goes on inside your head, she reminded us. It is shaped by the social and material world, and psychologists can therefore have ‘quite a broad brief’, including learning from other disciplines. Michie has found ways of informing policy beyond formal government structures, including as a member of Independent SAGE, calling for openness and transparency for better understanding and decision making, engaging with the public and policy makers. Ultimately, she said, there ‘should be no “hard border” between scientists and policy makers… we need engagement at all stages of the translational pathway’. Where next? Reicher warned that we still have ‘a narrative of blame and individual responsibility without support’. But for a positive note, he added that we are ‘starting to see local councils and voluntary bodies stepping in’, and therefore as psychologists we should do more to work with other organisations. JS

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The unique needs of female veterans Professor Dominic Murphy, Head of Research at charity Combat Stress, and President of the UK Psychological Trauma Society, spoke about an issue very close to his heart – the unique and understudied needs of female veterans. Since 2003, Murphy and his colleagues have been working on an epidemiological survey of mental health in veterans – this has involved three phases and 12,000 veterans at each phase of the study. Male veterans tend to come out most at risk, however Murphy had wondered whether comparing female veterans to male veterans rather than to females in the general population, was missing their unique needs and characteristics. Women make up around 11 per cent of the military population. Women were only allowed to join all branches of the military in 2018 and combat areas in 2016. Until 1991, women in the military who became pregnant were made to leave the service. Murphy worked with a woman who had left the service 10 years prior to their meeting, and struggled with two traumas. While working in Bosnia she gave food to a young boy outside the gates of her compound, but he soon disappeared. She asked around and was told he may have been targeted due to taking food from the British military. She also witnessed a helicopter crash while working as ground crew. In the chaos that followed she was lost in the darkness for a long time. Murphy said she found it extremely difﬁcult to seek support – because her traumas did not come from direct combat she felt she was somehow not allowed to receive support. Recently, Murphy partnered with the Women’s Royal Army Corps to carry out an online survey of 750 women veterans. He and his colleagues collected information towards the end of 2020 on demographics, military factors including veterans’ length of service, when they left the armed forces, and their ﬁnal rank before leaving, adversity and challenges they had faced, wellbeing and mental health. The majority of participants were over 60, and a quarter had left the military early – or before reaching four years of continuous service. Almost 30 per cent

reported four or more adverse childhood experiences (ACEs), many reported high military adversity including physical harassment, and 10 per cent reported having low social support. Nearly 30 per cent of participants had anxiety and depression, 11 per cent had experienced trauma, and Murphy found lower rates of alcohol use than expected. The rate of PTSD and common mental health issues was far higher in the female veterans than expected when compared with male veterans and the general population Murphy also found that experiencing more ACEs, common mental health difficulties, and physical health issues were all related to having PTSD. Female veterans were more likely to have had experience of ACEs than the UK general population – those with more ACEs were more likely to have been a lower rank, be an early service leaver, and have experienced adversity in the military. Many women felt they were treated differently in the military due to having childcare responsibilities. Some felt that sexist assumptions were made about them, and that they had to work even harder to achieve the same recognition as their male colleagues. Some felt they were made to leave the military due to having children, and after their service some felt less comfortable attending veteran events. Some had difficulty establishing a social life and transitioning to civilian life in general. In the survey, veterans were asked about any barriers they had experienced when seeking mental health support – 61 answered and Murphy examined their answers with thematic analysis. Some of the themes were a feeling of mental health stigma, a lack of understanding from professionals, feeling as if they were not ‘allowed’ to experience difficulties because they were not involved in combat, feeling services were designed for men, and those in the LGBT+ community felt discriminated against due to their sexual orientation. Murphy is currently working on phase two of this work, which will explore the specific traumas women have faced in the military and the experiences of LGBT+ veterans in more depth. ER

Knowledge is power, or ignorance bliss?

For our complete collection of coverage from BPS Conference 2021 – including keynotes from Professor Ann Phoenix and Professor Angelo Cangelosi, and symposia from the Crisis, Disaster and Trauma Section and the Political Psychology Section – see thepsychologist.bps.org.uk/ bps-conference-2021 14

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Would you lie to a loved one about their terminal condition, to ensure their last few months or years were as happy as possible? Professor Cass Sunstein (Harvard University) lived through this reality – after his father was diagnosed with a terminal brain tumour, his mother kept this from her husband. When involved with the Obama administration, Sunstein was a part of a group working on the inclusion of calorie data on food products – he was in favour of this information being included at cinemas. When he told his friend, the reply was, ‘Cass ruined popcorn’. In a world where information is so freely available, he said, these examples raise a question: how do we decide whether knowledge is power or ignorance is bliss? Sunstein set out to ask people whether or not they would like to know certain things – calories in their meals (43 per cent would), the year of their death (27 per cent would), whether they’d develop Alzheimer’s (around 47 per cent would). Sunstein gathered this data with no hypothesis – he was just curious – and started to ask what explains this need to gain or avoid information. He suggested that some information is simply useful. The calorie content of food, for example, can help us to make healthier choices. Sunstein calls this instrumental value. Some information may have neutral value or negative value. Some information may have hedonic or emotional value – for example in Sunstein’s example of his father’s brain tumour, the knowledge of this would have brought about certain emotions for him. Sunstein said we may wish to know some things even if they hold no value. He said we can think of this as cognitive value, for example knowing whether dogs are descended from wolves. Sunstein suggested that when people seek or avoid information they are making a judgement about the information’s instrumental, cognitive and emotional value. ‘This drives a lot of bafﬂing results

Does knowing the calorie data ruin popcorn? in the real world, where people don’t want information that, let’s say, questions their own political beliefs, or which suggests their investment portfolio is heading south.’ Another aspect to consider from psychology and behavioural economics, is that people are biased in their behaviour in predictable ways, and those biases may affect information seeking or avoidance. For example, humans are unrealistically optimistic, which can cause us to avoid important information. We also focus on the present rather than the past or future, and have an availability bias – we remember salient and familiar incidents better. Sunstein said he is not a mental health professional, but information seeking or avoidance could be associated with mental illness – or at least sub-clinical levels of distress. ‘This is meant to be suggestive rather than demonstrative. Some people who suffer from depression avoid information a lot, and their avoidance of information can be associated with the perpetuation of depression. ‘You can have a very bad spiral in which information wasn’t sought, then the depression continues or perhaps is deepened by the absence of information, which continues information avoidance, and it’s a spiral that has to be broken in one way or another.’ Sunstein hopes we will learn more about when it is accurate to say that knowledge is power and ignorance is bliss. ‘I want to honour the human desire not to be terriﬁed or distressed by information disclosure… not by withholding information from people who desire it, not ever by lying… but instead by being attuned, in a way that is gentle and kind, to the possible adverse effects of telling people things they really don’t want to know.’ ER

the psychologist september 2021 news

A healthy community Ella Rhodes and Jon Sutton with some highlights from the Division of Health Psychology’s Annual Conference. Why would someone living with a chronic condition fail to take their medication regularly? Professor Madelynne Arden (Sheffield Hallam University) said she often hears from people baffled by that, and unaware of the complex factors underlying medication adherence. Arden has been working on ways to support people with cystic fibrosis to improve theirs. In this condition, patients use a nebuliser to inhale antibiotics and mucolytics. As with many long-term health conditions, adherence is low. Advances including microchips in nebulisers have helped researchers and healthcare professionals understand why, when, and how adherence to medication might decline or increase. Having an objective measure is important – self-reported adherence has been found to be around 80 per cent, while chipped nebulisers have revealed adherence to be around 35 per cent. Without true measures of adherence, Arden said, interventions to increase it may not be successful. In developing an intervention to tackle medication adherence in cystic fibrosis, Arden and colleagues used a person-based approach – seeking feedback on earlier versions of a digital intervention from health care professionals and patients. The eventual intervention, CF Health Hub, saw 608 participants take their medication as normal but with sessions learning about behaviour change – including goal-setting, problem solving and building confidence – via an in-person interventionist and in an app. They could also view their own nebuliser data. At the end this intervention group had significantly higher medication adherence than the ‘care as usual’ control group. Arden and her colleagues have now worked to train healthcare professionals to use this intervention, and to extend its use into children and young people: Arden said a key aspect coming out of a trial with teenagers is a need to support parents to take a step back from treatment so children and can learn to self-manage their medication. Cystic fibrosis centres in the USA and France have shown an interest in adopting the intervention, leading to the development of CF DigiCare as a way to use data gathered to help to make healthcare better for people with cystic fibrosis. The data from people who were happy to share it revealed that half of adults with the condition are taking a third of their treatment – very different from the intervention trial’s results. Arden said this shows that research is based on an engaged and adherent subsample of patients, risking missing the full picture. Arden’s talk was titled ‘It is unclear why adherence is so low if the condition is so unpleasant and life threatening’, a sentiment she hears often. ‘Adherence doesn’t become easier just because the condition is more threatening. [In terms of the COM-B model of behaviour change] there’s capability opportunity and motivation barriers, and a clear lack of awareness that that’s the case… part of our job is explaining this, and part of our job is addressing it.’

The closing keynote was Professor Victoria Tischler’s ‘confessions of a transdisciplinary scholar’. She packed her presentation with examples from a career where she has ‘often felt a bit like a maverick’, using art as communication and intervention in areas such as identity and dementia. Art can, Tischler showed, transcend language, for example with the self-portraits of William Utermohlen as his health declined. She took us into the ‘sometimes surreal world I experience working with people with dementia’, for example doors disguised as bookcases to provide an ‘exit diversion’. Tischler has, though, ‘learned never to underestimate the capacity and agency of those living with dementia’, including how this can be increased through, for example, the use of Boots the Chemist’s archive to trigger autobiographical memories through smell. A recent Culture Box study (www.cultureboxstudy.org) co-designed creative activities in care homes, and ultimately it’s this aim that shines through in Tischler’s work: to ‘work towards parity with participants’, to address ‘wicked problems’ through a ‘complex interplay of domains of knowledge’. ‘This is the most impressive thing I’ve seen us – you – do’, said Professor Marie Johnston (University of Aberdeen) in discussing a truly inspirational symposium on health psychology’s impact throughout the pandemic. Contributors discussed, in Johnston’s words, ‘what we do to make the science work’, beginning with Dr Roseanna Brady and Dr Eleanor Bull on practitioner health psychologists supporting the frontline workforce. Professor Chris Armitage (University of Manchester) showcased the development of a method for expert consensus; producing guidance quickly, yet in an evidence-based way which avoids mixed messaging. This ‘Template for Rapid Iterative Consensus of Experts’ generates health psychology guidance ‘in a trice’. That tension, between doing good, slow, scientiﬁc research, and not missing the opportunity to have an impact on policy, was evident throughout. The pandemic has called for novel solutions, and several have stemmed from the Health Psychology Exchange (HPX) network: including Dr Tracy Epton crowdsourcing rapid reviews, and Dr Ellie Whittaker (North Yorks Council) setting up a ‘Public Health Forum’ to share guidance on vaccine uptake. In the discussion, Professor Lucie Byrne-Davis (University of Manchester) suggested the agility of the network was rooted in the fact that nobody was expecting to be paid, instead adopting ‘the Joe Wicks principle – we’ll do it for free, for now’. Professor Angel Chater (University of Bedforshire) added that ‘what we’ve achieved is brilliant, but we need to normalise timescales in terms of what public health can expect. Good quality can reduce costs later down the line.’ Back to the ever-insightful Johnston, who asked ‘what are you going to take on next? But my main point is “bloody wonderful”.’

Much more from the DHP conference: via www. thepsychologist. org.uk/healthycommunity

Making work healthier

While psychologists have a long history of supporting national policy to improve safety at work, their contribution to workplace health has perhaps been less prominent. Two psychologists who work on a Health and Safety Executive (HSE) committee spoke to Ella Rhodes about how this is changing, and psychology’s place in ensuring work does not adversely affect people’s physical and mental health. Psychologists Dr Joanna Wilde and Dr Emma Donaldson-Feilder have both been involved with the HSE’s Workplace Health Expert Committee (WHEC) for a number of years, given their familiarity with research evidence in the ﬁeld and experience of working within organisations. The role of the committee, which also includes experts in occupational medicine, human factors and occupational health practice and provision, reviews evidence on emerging workplace health risks to support the HSE science division. Recently Wilde and DonaldsonDr Emma Donaldson-Feilder Feilder have contributed to a rapid review of the evidence on Covid-19 testing in the workplace, examined the evidence on evaluations of interventions in the workplace which aim to reduce ill-health – both physical and mental, and helped with a review of the occupational factors in suicide risk. Donaldson-Feilder ﬁrst provided input to the HSE in 2003 when she was involved in consultations on their management standards for preventing stress. ‘There’s more recognition now that mental health isn’t just an individual issue – that we need to look at psychosocial environment and recognise that there’s a systemic element to it.’ When asked about psychology’s role in supporting the understanding of health Dr Joanna Wilde in the workplace, Donaldson-Feilder said a lot of focus in the past had been on the importance of stress, mental health, and human factors. ‘Part of our role initially was to make sure the focus wasn’t all about lung disease, diesel fumes and repetitive strain injury, and that there was a consideration of mental health and the psychosocial environment. It also involved saying that it’s all well and good to put in place an exposure limit on a particular chemical, for example, but what about the behavioural aspect of whether people will actually comply with that? ‘More recently, we have increasingly sought to raise awareness of how a failure to engage with the behavioural and contextual issues around an intervention can impact intervention success and potentially lead to unintended

harm; for example, the potential negative impact on trust was a signiﬁcant issue raised in the review of the use of Covid testing in the workplace.’ Since joining the committee, Wilde has been keen to emphasise the complexity of the workplace environment when introducing interventions aimed at supporting or improving employee health, as well as the evidence base underpinning intervention design and implementation. Three main concerns were of particular interest to Wilde when speaking with the committee on workplace interventions, incorporated into the recently published WHEC evidence review on the topic. She said that a focus on mental health alone has meant that organisations can ignore, and even worsen, the occupational factors which affect employees’ physical health. She said this was because focusing on mental health tended to frame the problem as located in ‘the individual’ rather than a consequence of known psychosocial hazards in the workplace environment. ‘One of the key hazardous psychosocial exposures in the workplace is the combination of high demand and low support and these exposures, evidenced in longitudinal studies of work-related psychosocial exposures and biomarkers of inﬂammation, are implicated not only in psychological health outcomes but also in long-term physical health problems.’ Many workplace initiatives to improve employee mental health can, paradoxically, end up increasing psychosocial hazards in the workplace and use additional resources within the organisation which may be better used elsewhere, she said. ‘One of the key conversations that we wanted to broker in WHEC is that we need to have a much more sophisticated understanding of what causes unintentional harm, and therefore how we can intervene in these psychosocial exposures.’ Another concern for Wilde was that much of the research examining the relationship between work and health tended to focus on the ways work can be good for health, but she said this could create a framing effect that ignores how work can harm health, and also how unsophisticated interventions aimed at mental health in the workplace can contribute to this harm. ‘I really wanted us to look at the emerging literature in psychology about the way in which psychological ideas have been implemented in a way, which, paradoxically, increases harm.’ Wilde gave two examples – designing and implementing interventions that focus on individual behaviour without acknowledging the role of context – which she said have been demonstrated to worsen the outcomes an intervention aims to improve. ‘The other issue manifests, for example in the implementation of Mental Health First Aid, which has been rolled out in many places, but has been understood and deployed in a manner that had not been anticipated in its design. This adds demand, a known psychosocial hazard, to Mental Health First Aiders, exacerbated by a lack of support as

the psychologist september 2021 news

there is no clear regulatory framework equivalent to that for workplace physical ﬁrst aiders.’ Another area for attention, Wilde said, was the contribution of work as a social determinant of health and health inequality. ‘We need to conceptualise and think about bad work and its impact on health. This is particularly important in workplaces that have been described as ‘two tier workplaces’: one tier is those on precarious, zero-hours contracts earning low wages, managed remotely often via a technology platform, with the other tier being the professional staff running the platform organisation. However, the psychological trauma experienced from bullying and discrimination are also relevant considerations when addressing the issue of bad work and its impact of work-related health outcomes.’ Looking to the future of WHEC’s work, DonaldsonFeilder said some of the committee’s members have been asked to act as a small governance group on the National Core Study research programme on environmental and transmission risk factors for Covid, which includes exploring transmission mechanisms and controls in workplace settings. The committee is also hoping to share the evidence reviews it produces more widely. ‘When the committee was set up it was very much couched in terms of giving advice to HSE but I think there’s a realisation that the papers that we are producing are actually of value to a much wider audience, and we have been thinking about how we can get our existing work out to audiences much more broadly.’ The HSE has also posed a question to WHEC on fatigue and mental health in the construction sector. Donaldson-Feilder said that understanding the factors that increase risk to mental health and intervening to reduce risk is not a simple matter; it involves engaging with the full complexity of the psychosocial environment in which workers – in this case construction workers operate. ‘I think this could build on the interventions paper that Joanna spearheaded, exploring the complex systemic nature of psychosocial hazards, multi-level and multifactorial causation, and how we might intervene to create an environment that is more conducive to workplace health – be that workplace physical health or workplace mental health. My aspiration is that, in the long run, we get to a point where we are helping employers create cultures of genuine care, where we are building compassion and care into the system, into attitudes, into the way organisations are run and managed and led.’ For more information on WHEC see: https://www.hse.gov. uk/aboutus/meetings/committees/whec/index.htm For more information on the National Core Study see: https://www.hdruk.ac.uk/covid-19/covid-19-nationalcore-studies/ To read WHEC’s rapid review of workplace Covid testing see: https://www.hse.gov.uk/coronavirus/assets/docs/ testing-and-the-workplace.pdf

Changing humanity for the greater good The BPS has published a new strategic framework which lays out the organisation’s purpose, vision, values, as well as six strategic goals – which encompass the society’s intent and aspirations. The document, which will take the society to the end of 2022, was 18 months in the making through extensive collaboration with members. In terms of its purpose – aimed to deﬁne ‘who we are, why we exist and how psychology will impact the world at large, not just now but in the future’ – the BPS emphasises that it is an inclusive, member centred organisation, there for a diverse membership who it supports at every stage of people’s careers. ‘We will work collectively to advance evidence-based psychological knowledge, pure and applied, through education, research, practice and innovation. We will prioritise the society’s resources to deliver inﬂuential, effective and impactful outcomes for our members, the people they support and wider society beyond membership.’ The vision statement in the document sets out the society’s ideal

of promoting inclusivity and diversity and being the “voice of contemporary evidence-based psychology that improves lives and changes humanity for the greater good”. The document also covers the society’s values – inclusivity, integrity, respect, collaboration and impact. The six strategic goals laid out by the BPS are to promote and advocate for diversity and inclusion in psychology and eradicate discriminatory practice, create a member-centred community with a meaningful membership identity, promote the value of and encourage collaboration in interdisciplinary development and engagement, to be the home for all psychology and psychologists and uphold the highest standards of education and practice, increase its inﬂuence and impact and advance its work on policy and advocacy and to strive to be more innovative, agile, adaptive and sustainable. To read the full strategic framework see: www.bps.org.uk/news-andblogs

‘Mass infection not an option’ Psychologists continue to be vocal in their responses to the UK government’s actions around coronavirus. A recent letter to The Lancet, from scientists including John Drury, Stephen Reicher, Robert West and Susan Michie, called ‘Freedom Day’ ‘dangerous and premature’. ‘… the government should delay complete re-opening until everyone, including adolescents, have been offered vaccination and uptake is high, and until mitigation measures, especially adequate ventilation (through investment in CO2 monitors and air filtration devices) and spacing (eg, by reducing class sizes), are in place in schools,’ the group argued. ‘Until then, public health measures must include those called for by WHO (universal mask wearing in indoor spaces, even for those vaccinated), the Scientific Advisory Group for Emergencies (SAGE), the US Centers for Disease Control and Prevention (ventilation and air filtration), and Independent SAGE (effective border quarantine; test, trace isolate, and support).’ Read the letter at https://tinyurl.com/y29dmk54

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Let the children play Emma Young digests the research

Find our Research Digest at www.bps. org.uk/ digest

As children head back to school, teachers and parents will of course be concerned about kids catching up on their education after the Covid-19 lockdowns. But, as many psychologists have pointed out, they need to catch up on play, too. So what does the research tell us about the need for and the importance of play?

First: why do kids need to play? Editor: Dr Matthew Warren Writers: Emily Reynolds, Emma Barratt and Emma Young

Well, of course, it’s fun – and as we all know, having fun is critical for kids’ psychological wellbeing. But there are also all kinds of documented developmental beneﬁts. For example, play helps children learn how to interact successfully with others and to get better at regulating their emotions. Kids also learn through play: as we discussed in episode 24 of our PsychCrunch podcast, it helps them to develop concepts and skills, including mathematical concepts and problem-solving, and to stretch each other. If they are running around and navigating obstacles (even if those obstacles are just other kids), it also trains their senses – especially Reports, proprioception and their vestibular senses. For all sorts of links and reasons, it’s vital. In fact, the UN Convention on the Rights more on of the Child states clearly that ‘every child has the right… the Digest to engage in play’. In one pre-Covid-19 survey, children website in Wales were asked what they would change to make themselves healthier and happier – and more time and space to play and feel safe was a top response. Look out for BPS activity around play during September… Don’t drop afternoon breaks Many UK schools have now shortened or even

dropped afternoon break-times, replacing them with extra teaching time instead. Given the reduced teaching during lockdowns, more schools may ﬁnd it tempting to lose that break. But there’s evidence that this would harm children’s wellbeing. The HAPPEN (Health & Attainment of Pupils in a Primary Education Network) project with children aged 9 to 11 in Wales found that those who had afternoon breaks were physically ﬁtter, for example, and, notably, they did no worse in Key Stage 2 tests than children who’d instead been taught during this time. Physical activity doesn’t have to be restricted to break time and PE lessons, however. A preliminary trial on 8- to 9-year-olds in 10 London schools, led by Emma Norris and reported on the Digest in 2018, found that those in active maths and English lessons – in which they ran on the spot, for example, while answering questions – were more focused in the class.

There are other benefits to playing outside For one, as supported by a recent paper in Scientific Reports, the increase in myopia (short-sightedness) in many countries has been linked to reduced time spent outdoors in childhood. Regular playtimes in green spaces, such as parks, are also associated with milder symptoms for kids with ADHD (according to a 2011 study from Andrea Faber Taylor and Frances Kuo). And there could ultimately be environmental benefits from kids spending longer outside, too: work led by Catherine Broom at the University of British Columbia, Canada, has linked time spent outdoors in childhood to a love of nature and concern for the environment in young adulthood.

the psychologist september 2021 digest

Make ‘enhanced’ pretend play part of the curriculum? Periods of time devoted to imaginative play are common in preschools and in classes of younger school children. Certainly, they give kids the opportunity to learn how to interact well with others. But Édouard Gentaz at the University of Geneva and colleagues wondered whether teacher-guided pretend play sessions that focused more explicitly on social and emotional development might have extra beneﬁts. They recently ran a study involving classes of 5- to 6-year-olds in Valais, Switzerland. Some of these children got 11 hour-long weekly play sessions guided by a teacher who had been trained to encourage them to pretend to be bursting with joy, for example, or who challenged them to solve a dispute, while the others had non-guided pretend play sessions. The team found that the children who’d been guided were better at recognising emotions and had a bigger emotional vocabulary. Whether or not that translates into better interpersonal skills is not yet clear. A more extensive trial is now underway, again in the region of Valais.

Don’t panic about newly aggressive pretend play

Multiple factors influence how we perform educationally: the way we’re taught, our particular needs and how they’re met, our parents, and our socio-economic background to name a few. Gaps in attainment can start from very early on: some children have already fallen behind before the age of seven. But what about how much we enjoy school? A new study in npj Science of Learning, led by the University of Bristol’s Tim Morris, looks at this relatively underexplored factor. And the team finds that enjoyment at the age of six has a significant impact on achievement, which was visible even years later when participants took their GCSEs. Data was gathered from participants in the Avon Longitudinal Study of Parents and Children, which has been tracking parents and their children from 1991 onwards. At the age of six, participants were asked if they liked school, before answering further questions on their enjoyment six months later.

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After the pre-Easter lockdown, my 10-year-old came home with all kinds of stories of playground bust-ups. I’m sure the same thing happened in every school. After so long in isolation, it’s no wonder that some kids struggled with managing anger. For a minority, though, this is an ongoing problem. And a recent study led by Zhen Rao of the Centre for Research on Play in Education, Development and Learning at the University of Cambridge found something really interesting about the impact on classmates. The team observed children aged 7 to 10 in China while they played with toys in pairs. (The toys were ‘neutral’; there were no toy guns, for example.) The results showed that when a child was paired with one who was deemed by fellow classmates to be bad-tempered, that ﬁrst child was 45 per cent more likely to introduce aggressive themes into their joint play. The child’s own temperament didn’t seem to inﬂuence this – it was to do with who they were with. A lot of research on aggression in play has focused on potential associations with the child’s own temperament. But the study suggests that kids use play as a safe context in which to explore how to best handle an aggressive person in real life. For some children, then, aggressionthemed play may not be a sign that they struggle to ‘play nicely’ with other kids, but rather a sign of socialemotional learning. All of this work argues that as our children go back to school, teachers should keep sight of what of course they know to be true – that play time as well as study is vitally important – while parents can ensure that children get as much play, and especially outdoor play, as possible.

Children who enjoy school aged six tend to get better grades 10 years later Educational attainment was measured through exam results aged 16, and the team also looked at sex, month of birth and school year, ethnicity, cognitive ability aged eight, maternal education and the socioeconomic position of parents. Mothers who took part in the study also reported how much their children liked their teachers aged six, and children themselves selfreported their temperament by answering questions on how happy or angry they were. From the age of eight, children answered questions on their conﬁdence in their work and intelligence, as well as how happy they were with their number of friends and the quality of their friendships. Finally, the team looked at the home learning environment through questions on how families taught their children colours, language, numbers, songs and shapes and sizes. There was no relationship between school enjoyment and parental socioeconomic status: those who had parents in so-called ‘skilled’ occupations were just as likely to enjoy school as those in ‘unskilled’ occupations. Children with higher cognitive ability were more likely to enjoy school than not, girls were twice as likely to say they enjoyed school than boys, and non-white children were almost twice as likely to report enjoying school than their white counterparts. Unsurprisingly, there was a strong relationship between children’s opinion of their teacher and how much they enjoyed school: those whose parents reported that they liked their teachers were more than nine times more likely to enjoy school than those who did not. Similarly, those who had conﬁdence in their work also enjoyed school more.

Enjoyment of school didn’t just have a short-term impact, however. Those who enjoyed school at age six scored on average 14.4 more points at GCSE – a difference of two grades – even when the researchers had controlled for other factors related to educational achievement like cognitive ability and family socioeconomic status. They were also 29 per cent more likely to obtain ﬁve or more A*-C grades, including those maths and English qualiﬁcations so crucial for employment. In fact, enjoyment of school aged six was almost as strong a predictor of

educational achievement aged 16 as other factors such as sex and socioeconomic status. It may seem obvious that enjoyment of school has an impact on grades. But it’s striking that enjoyment at age six may impact grades aged 16, particularly when you consider its relative importance alongside factors like gender and cognitive ability. The results also appear promising for potential interventions. Enjoyment is potentially more modiﬁable than socioeconomic factors; designing interventions that

target school enjoyment and promote positive feelings about school could therefore have a signiﬁcant impact on attainment many years down the line. The team notes that the results should not be taken as a deﬁnitive way to address inequality in education, an issue which is clearly complex and multi-layered; future research could also explore why children do or do not enjoy school and how this interacts with external, social factors. However, thinking carefully about enjoyment could be one piece in the jigsaw of academic attainment. EMILY REYNOLDS

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The ‘liking gap’ refers to the finding that we often (incorrectly) think that other people like us less than we like them. Now a new study has found that this phenomenon is first seen in kids as young as five years old. The research has practical implications: for instance, parents and teachers can reassure kids that their judgements about what their peers think of them are likely to be overly negative, which could be of particular help to those who are worried about their relationships with classmates. (Psychological Science)

the psychologist september 2021 digest

Digest digested…

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Social media posts from politicians and conservative or liberal media outlets get more shares when they contain more language referring to political opponents. These posts may be so popular because they appeal to feelings of anger and outrage towards the political out-group, write the researchers behind the new study, who hope that the ﬁndings can help us understand how social media

contributes to political polarisation. (PNAS) People tend to believe that psychology is a ‘feminine’ discipline, according to a recent series of studies. Participants rated stereotypically feminine traits as better suiting psychology students, for instance, and when they learned that there was a higher proportion of women than men studying psychology, they felt that men’s needs may not be met by psychology as a career. (Journal of Social Psychology) A new study has found that people in positions of power are more likely to adopt a ‘choice mindset’, in which they view the actions of others as ‘choices’ driven by their own motives and preferences. This

in turn increases the chance that they will blame and punish others for poor performance. Powerful people may beneﬁt psychologically from believing everyone’s position is related to choice, as this would imply that they had reached their own position through merit and hard work. (Social Psychological and Personality Science) Blaming the pandemic for your stress could be good for your relationship, according to a diary study of American couples living together during lockdown. On stressful days, when women blamed the pandemic they reported greater satisfaction in their relationship than those who did not (though the same result was not seen for men). They also reported behaving in fewer negative ways towards their partners. (Social Psychological and Personality Science)

Imagine that you’re with your partner at a party and you both get chatting to a stranger. Your partner and the stranger get on really well. Before long, they’re laughing away and ignoring you. Which would hurt most: rejection by the stranger, or by your partner? The answer, according to new research in Social Psychology is that – in the moment, at least – they would hurt the same. Anne Böckler at Leibniz University in Germany and colleagues asked participants to come to the lab with either a friend of the same sex or a romantic partner. While in a separate room from their friend/partner, they played a screen-based ball-tossing game with what they thought was their friend/partner and a third online player. In fact, the passes from this other ‘player’ as well as the passes that the participant believed their friend/partner to be making were controlled by the researchers. ‘Included’ participants received 20 of the overall 60 passes (as would happen if the ball tosses were equally shared). Those who were ‘excluded by their friend/partner’ received 10 passes overall, all from the stranger. Those who were ‘excluded by the stranger’ also received a total of 10 passes, but all from their friend/ partner. People in the fourth group were more completely excluded: after receiving two passes at the beginning of the game, they were then ignored. Immediately after the game, participants completed questionnaires about their mood during and after playing. These revealed that exclusion dampened people’s mood during (though not after) the game, and the effect was similar whether they had been excluded by a partner, friend or stranger. Being excluded also had a

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Social rejection hurts, even from a stranger

negative effect on other measures including feelings of belongingness, self-esteem, and relationship satisfaction; again, it didn’t make any difference whether they had been excluded by a close other or by a stranger. (Total exclusion had an even greater effect on most of these measures.) This is a small study, however, and it focused on impacts during and immediately after the game. Rejection by a romantic partner or close friend would surely have longer-lasting effects – even if indirectly, by altering perceptions of the quality of the relationship itself. EMMA YOUNG See also our collection at thepsychologist.bps.org.uk/ psychology-friends

‘Sometimes the whole room morphs into a different place’ Lee Jones discusses Charles Bonnet Syndrome with Keith Valentine and Judith Potts

Dr Lee Jones is Post-Doctoral Research Fellow at both Moorfields Eye Hospital and the UCL Institute of Ophthalmology, where he studies the impact of eye conditions through a health psychology lens. One of his areas of interest is Charles Bonnet Syndrome – a condition in which those with degenerative eye conditions experience visual hallucinations, including patterns, scenes, animals and figures. The prevalence of this syndrome is disputed, but it may affect up to one in five people with vision impairments and sight loss. Lee spoke to Keith Valentine, Director of Development at RNIB, who has retinitis pigmentosa and experiences Charles Bonnet Syndrome; and Judith Potts, founder of Charles Bonnet Syndrome campaign group Esme’s Umbrella. What are their experiences of the condition?

Keith Valentine

Lee: Keith, could you tell us a little bit about yourself and how CBS affects you? Keith: In my professional life I’m the director of development at the RNIB. That involves planning strategy and the insight functions that help the organisation understand the lived experience of blind people. I was diagnosed with retinitis pigmentosa when I was 11 years old. In the preceding 10 years many members of my family had also been diagnosed, and my mother had her diagnosis three or four weeks before me. I started to experience Charles Bonnet Syndrome without any concept of what it was. I was coming back from watching the Six Nations game in the pub. When I got back to my flat, I opened the door and there was a First World War soldier, with his face severely injured, standing in the middle of my front room. My experience of sight loss is like looking through a fog… it’s been described as a smashed mirror with bits moved off and Vaseline rubbed all over it. My visual environment is very confused and very mobile – there’s lots of flashing and things moving around – so it was odd to see something with such clarity. I also sometimes see woodgrain covering everything, which is quite common. I went through a phase of seeing staircases in pavements, but less so through lockdown as I’m not really in the environments where I see them. Generally it’s the big London streets where I see that – it’s actually particularly bad on Euston Road, where there actually are staircases in the pavements! It’s something that’s part of my life now, and I think I’m able to enjoy the colour of it, and get some satisfaction from it. I don’t know if that sounds perverse, but in a world without visual clarity I can sometimes enjoy things that exist with visual clarity. Lee: How did you feel in those initial stages when the hallucinations first began? Keith: There was a very small gap between me seeing the figure for the first time and raising it with my family, particularly my mother. She raised me and my brother as a single parent in a tower block on Walthamstow Market, while experiencing sight loss

the psychologist september 2021 charles bonnet syndrome Nick Ellwood/www.nickellwood.co.uk/

arrogance in the modern world. I should have at least herself. She was bullied at work as a consequence of considered it for a minute! sight loss. When I spoke to my mum she swiftly said ‘oh yeah I see stuff’. She’d never mentioned that before, Lee: Are there any other occasions of experiencing but she sees huge pythons on pavements quite a lot these hallucinations that stand out to you? when she’s walking around. I don’t know whether it is triggered by certain patterns in the visual environment, Keith: I chaired the Vision UK Conference at the Queen Elizabeth Conference Centre two or three but she often sees them on zebra crossings. Recently years ago now. I was chairing the she’s been seeing the Coronavirus, conference, chairing the panel those images that come up on the at the end, and doing news, floating around the house. I “When I spoke to my mum discussion a keynote speech, and I was was quite startled by that because she swiftly said ‘oh yeah absolutely exhausted by the end of I’d never thought of it as something the day. When I walked across the that had any material relationship I see stuff’. She’d never stage, using a white cane, to stand to what you were consuming. mentioned that before, at a lectern in front of 500 people I am very conscious that I’m but she sees huge in a great big hall, I started to talk losing my sight and experiencing and then saw my soldier standing things like Charles Bonnet pythons on pavements there in the middle of the main Syndrome from a position of quite a lot when she’s aisle at the back. That was kind relative strength – I don’t have to walking around.” of nice – I’d rather all these things carry the concerns of the rest of weren’t happening to me, but when my family around sight loss with it turns up on a day like that and me, because many of them are just stands there looking all odd I kind of took comfort living with it. My first time seeing the images was from it. Not that it would have called out if I’d missed scary… when I saw the soldier for the first time it was my line or anything like that but there’s something frightening because I thought it was the worst kind of about the routines of sight loss that can be perversely burglar, the one that doesn’t run away. I never thought comforting. that I was going mad, which is a worrying form of

Lee: How would you say your Charles Bonnet Syndrome has been affected over the last year or so, with the pandemic and lockdowns? Keith: It’s no more frequent, the incidental stuff is a bit more colourful at times. When the soldier appears – it’s strange the way it happens now – where before it would be innocuously standing in spaces, it’s more recently felt more intimidating. It doesn’t actually move around or anything, it just stands there, but to have it standing right up against the window is very different than if I was just conscious that it was out in the garden. I often see people with different faces. I can’t see anyone’s face anymore, and a lot of the time people I’ve known in the past seem to crop up. When it ﬁrst started I was routinely seeing facial disﬁgurement on people I was talking to. They often have their bottom jaw missing, and that is starting to occur more frequently. It’s noticeably different but not dramatic, I would say the difference is it feels a little bit darker. But then my broader sense of self and what’s going on, as with all of us, is a little bit disturbed by the presence of the disease in the community.

Judith Potts

Lee: Judith, could you tell us about yourself and how Esme’s Umbrella came about? Judith: My mum was the Esme of Esme’s Umbrella, she was in her early 90s, very independent, very bright, intelligent, she did the Telegraph cryptic crossword every day, and she seemed ﬁne. I knew she had glaucoma but I realise I didn’t understand what glaucoma really was. One day she said, ‘I do wish these people would get off my sofa’. I paused and she said, ‘well, they do go if I tap them on their shoulders’. And I thought, what is this? And while I was thinking what on earth I should say, she said there’s an Edwardian tear-stained street child who follows me everywhere and a hideous gargoyle-like creature that jumps from table to chair. She said sometimes the whole room, or garden in her case, morphs into a different place and she found herself in the middle of an Edwardian funeral procession with horses and the clergy in red cassocks. I thought this has got to be dementia, but it can’t be that, because of this ﬂipping crossword that she does! I was very fortunate and found a tiny paragraph in one of the health pages – there was an interview with a guy called Matt Harrison, who at that point worked for Beacon in Wolverhampton. He was talking about what happened to him, which was Charles Bonnet Syndrome. I thought great, I called mum and told her not to worry, and called the ophthalmologist. That was where it all went wrong. He refused to discuss it, and even sent a junior doctor to her next eye appointment with strict instructions not to discuss it. Her GP had never heard of it and thought I was being fanciful. Our optometrist had never heard of it. So, onto the internet I went, and I found Dr, now Professor, Dominic Ffytche, at King’s College London, and I went to see him. He agreed that that’s exactly what my mum had.

At the time I was writing a health column for The Telegraph and I said I’m going to start writing about this. And that’s what I did. A couple of years went by and it was clear my mum was getting worse – this was happening to her 24 hours a day. I thought I’ve got to do something but, actually, it wasn’t until she died that I really got my act together and launched Esme’s Umbrella because of an email that arrived after a column that I’d written. It was from a professor at a university in New York and she told me the story of her mum who had been put into a dementia unit. The doctor said she was obviously demented: she was hallucinating worms and slugs in her food in her drink. The family thought she was perfectly sane, and this poor woman couldn’t get past the worms and slugs. There was no one who’d heard of Charles Bonnet Syndrome. She stopped eating and drinking and died. That was so appalling that I thought, right, I have to do something. So in November 2015, at the House of Commons, I launched Esme’s Umbrella in memory of mum, with three aims – one was obviously to raise awareness of this, because clearly no one had heard of it. Secondly, to create ways of supporting people who develop it and their families, and thirdly, to source funding for research, because I am a campaign not a charity, so I take my begging bowl out and ask for money. Lee: How would you say that awareness of Charles Bonnet Syndrome has changed over the last few years? And what do you think that change has meant to people living with CBS? Judith: I think, blowing my own trumpet here, I have raised awareness, and more and more people know about it. Professor Ffytche has proved that if a warning is given to the patient before the ﬁrst hallucination appears the outcome is much better. Because they see a hallucination and think ‘oh, yes, I was told something like this might happen’. It might still be horrible, they might never come to terms with it, but that initial shock and horror is not there, and therefore it’s easier to cope with. I think it’s been proved by the patient awareness day that we held online last November that awareness has been raised because of the number of people that attended. Also, the number of people that write to me from all over the world. I also worked with scriptwriters on Coronation Street, and we know that that is watched by between seven and 10 million people. All those people will have now heard of Charles Bonnet Syndrome, so that will have made a big difference. I know from the Facebook page how many people are in desperate need. My helpline is answered for me by the eye health team at the RNIB because it just got too much for me, because Esme’s Umbrella is only me. In the three days after the diagnosis was revealed in the episode of Coronation Street, my helpline received just under 1900 calls. Doctors from around the world are calling and contacting me. I was contacted recently by an

the psychologist september 2021 charles bonnet syndrome

have found a link between social isolation and ophthalmologist in Paris who wrote to me because visual hallucinations, so we carried out a survey he was very ashamed – he said he thought this was online and by telephone of 45 people with CBS incredibly rare until he looked at my website and about their experiences. We found that 56 per cent realised that it is very common, and we have to do of those people were experiencing more frequent something about it. And I wrote back and said, ‘yes, hallucinations. For example, people described how you do, actually, so would you get on please and do they were now experiencing hallucinations several something!’ There are people all over the world with times per day, whereas prior to the lockdown it was this, Professor Ffytche reckons that there are probably once or twice per week. Around half of the people we a million in this country… so how many are there in spoke to said the nature of their hallucinations had America, Australia, South Africa, India? changed, and they were finding them increasingly When people know what it is, it does help, but as difficult to cope with. For example, some told Keith says it can get in the way of everyday life even if us that ghostly figures had started to appear in what you see isn’t frightening. One lady said to me the their homes, often with grotesque facial features, other day that she was making a cake and suddenly such as jagged teeth, and bloodied or melting leaves and twigs were falling into the bowl that she’s faces. Some also described experiences similar to mixing the cake in – you just have to stop until that prosopometamorphopsia – where faces become goes away. strangely disfigured. There are two quotes from lockdown I remember We found that there was a in particular – one was from a statistically significant association lady who said that she’d lost between self-reported feelings her sight six years before, so for “the local charities who of loneliness and changes in the six years she’d seen no colour. host groups over here phenomenology of CBS. Our Suddenly Charles Bonnet findings also suggested that Syndrome developed and she said are lovely, but people people who felt lonelier during it’s stunningly beautiful – like want to know that there the pandemic were, on average, watching a gardening documentary, is a medical person that older than those who did not she sees the colours of the flowers report feeling lonelier. We think and the plants and the trees, a they’re talking to.” this finding might point to a drop of rain on a leaf. She said it’s difference in the needs of visually wonderful. The only problem is she impaired older adults compared to cannot choose when she sees it so older adults without vision impairment and it raises it can interrupt her life at any time of the day. On the important questions around the manifestation of other end of the spectrum is the man who told me it’s loneliness among the visually impaired. like watching a horror film that he would never have Is there anything you’d like to see in the future for chosen to watch and which he can’t switch off. people experiencing Charles Bonnet Syndrome? Keith: If there’s anything that I could do right now it Lee: Would you say that over lockdown you noticed would be to get the money to further the research that a change in the number of phone calls you were you and other colleagues are doing. It’s something we receiving, or the nature of the types of complaints have to persist with. I firmly believe that if people are and problems people were experiencing? aware of it, and they can understand it for themselves Judith: Yes definitely. A week into lockdown, a guy and their family, then the experience for the patient called Mike Bailey, who works in Liverpool for a big will be that much better than it would be but also the charity called Christopher Grange, contacted me world’s sensitivity to it would be improved as well. and said that he’d been running a group. He said Judith: I think it would be great if psychologists over we had to do something because his members were here volunteered. There is a guy in America, a clinical contacting him and were having a really difficult time. psychologist, who works exclusively with the visually So we launched telephone chat groups called Esme’s impaired – we don’t have that role here. They could Friends, and more and more people are joining those. volunteer to be on hand to talk to people and even to And I knew we were onto something when someone run the kind of groups that my friend in America does, at the RNIB called and said they were overwhelmed which are the same as Esme’s Friends. With the best with calls. She said the regular sight loss questions will in the world, the local charities who host groups had disappeared and the calls we were getting to the over here are lovely, but people want to know that helpline were all about Charles Bonnet Syndrome and there is a medical person that they’re talking to. Any how much worse the episodes are, how much more psychologist volunteers would be fantastic. I am also frequent the episodes are, and also that people were working with the nurses at the Manchester University seeing things which were much more frightening. School of Nursing and hopefully they’re going to go back to their NHS trusts as CBS champions. There’s Lee: This reflects what we’ve found in our work so much to be done to help this community and their with people experiencing CBS and the changes in children as well. their hallucinations during lockdown. Some studies

the psychologist september 2021 class Karla Novak (@karnovak)

Conversations on class Ella Rhodes and Annie Brookman-Byrne talk to psychologists about its impact

ome people view class, and class division, as something of the past – something which has little impact in a modern, apparently meritocratic, society. But might this view ignore the important experiences of many people thrust into undeniably middle class environments such as universities? Has psychology’s general ignorance of class in research missed something which many people see as key, and foundational, to their identity? Do we even know what we mean when we do speak about class? The Psychologist’s journalist Ella Rhodes and deputy editor Dr Annie Brookman-Byrne spoke to psychologists from working class backgrounds about their diverse, sometimes unsettling, experiences of coming from backgrounds very different from many at universities and other institutions. They covered their deﬁnitions of being working class, the research in the area, and what institutions might do to make working class people feel they belong in what can be a truly alien environment.

More than socioeconomic status There is a staggering lack of attention to class in psychology research, according to Dr Bridgette Rickett, Head of Psychology at Leeds Beckett University, who researches class through a critical lens. While class is sometimes inferred through socioeconomic status (SES) or parental attendance at university, Rickett is more interested in a holistic deﬁnition of class. Social class, Rickett tells us, is not a discrete or simple variable: ‘We should collect a number of measures if we’re seriously interested in class. SES is not a bad one – we cannot remove a sense of poverty from class – but a more complicated set of measures might help us.’ It isn’t possible to read social class from standard measures, Rickett says. ‘There’s a complicated interplay between those. For instance, class is often read by our language, speech style, lifestyle, where we live, where our family live, mode of appearance, how we dress. We’re read as working class even if our SES might not reﬂect that – so I think our subjective sense of class

Dr Bridgette Rickett, Head of Psychology at Leeds Beckett University

and who we belong to can sometimes be at odds with more formalised measures.’ Rickett thinks that the neglect of class in psychological research may be in part down to neoliberalism and the perpetuation of the idea that we live in a classless meritocracy. ‘It’s quite difficult to talk about class when we’re hearing this rhetoric that it doesn’t exist. There hasn’t been enough time given to measures to capture such complexity – but it doesn’t mean that class inequalities and oppression and poverty are something of the past or are no longer meaningful.’ There’s also the simple fact that it can make people feel deeply awkward. ‘Andrew Sayer, a sociologist, wrote quite a lot about emotion and class, and he said the paucity of research within psychology is because it’s a very embarrassing, unsettling topic for people, because it’s not supposed to exist, and systems are supposed to not allow for class prejudice... I think it’s led to a bit of an abdication from acknowledging that class relations and class difference exist within psychology, and I can’t really overstate how important it is that we move past this.’ In the rare instances that class has been considered, Rickett tells us, it has typically been to describe a deficit or problem in working class people. Researchers have ‘tended to look at how working class people are different in a way that’s morally poorer. How they’re not as intelligent, how they’re not as rational, how they don’t make healthy choices, why they behave so poorly, why they have less self-control – can you see the pattern?’ Shifting identities and standing out Rickett grew up in a traditional working class community in South Yorkshire. When considering her own identity, her feelings reflect her academic thinking. ‘I think class identity is defined and redefined relationally. My identity around my class may be different in regards to who I’m with, who I’m talking to, what system I’m in, what institution I’m in – it fluctuates and is fluid.’ Dr Emma Blakey, a Developmental Psychologist at the University of Sheffield, says that juggling a working class identity with a new-found middle class identity was like being in a ‘nether zone’. Blakey comes from a former mining town in Yorkshire, and initially felt like a fish out of water at university, experiencing something akin to culture shock. ‘You feel like you don’t fully belong at university but because you have to adapt to learn, neither can you belong fully at home with your newfound knowledge and vocabulary. You go home and end up accidentally using long words. Your family lovingly tease you. They see you changing

Dr Will Curvis, a Clinical Psychologist

and it makes them uncomfortable too. You fear you’re becoming pretentious, they fear they are losing you.’ Thanks to a supportive family, partner, and academic colleagues, these feelings have faded with time. Blakey has become comfortable shifting identities. ‘I now sit with these two identities and I feel I have a stronger grip on who I am.’ Rickett has similarly found managing identities difﬁcult. ‘I think I’ve struggled with a sense of belonging, identity and authenticity. Sometimes it’s left me severed from who I am as a working class woman and the middle class academic way of being has sometimes left me feeling a little bit of strain.’ Dr Will Curvis, a Clinical Psychologist, grew up in the historically working class town of Wigan. But having parents who both worked in roles that were nothing to do with psychology (dad as an electrician, mum as a dinner lady at a local primary school), and not experiencing poverty, Curvis has also struggled with juggling his identity. ‘There’s always this feeling of, am I working class, or working class enough, it’s a really tricky thing. I think when I was training it was something I thought about quite a lot but didn’t really have the language for. My cohort were wonderful but I did often feel quite different, I felt like a bit of an outsider, I felt like my background was different – particularly when talking about my relationship with education and where I went to school. I think it’s taken me a bit of time to feel more comfortable with the shift from being someone quite proudly from a working

Dr Emma Blakey, a Developmental Psychologist at the University of Shefﬁeld

the psychologist september 2021 class

class background into doing a job that is more middle class.’ We repeatedly heard in our conversations that psychologists from working class backgrounds didn’t realise they were working class until being thrust into the middle and upper class environment of university. ‘The funny thing is’, Blakey says, ‘I didn’t know I was working class until I started university and then my working classness stood out’. Blakey adds that interactions with other students at university led to feelings of alienation in small but signiﬁcant ways – through the way other students talked, the food they ate, and vastly different experiences of life and travel. Forensic Psychologist in training Edite Sustere feels that her working class identity became increasingly apparent as she progressed through her education. Sustere is originally from Latvia and moved to England at the age of 13, living in lower-income areas. She noticed how little she had compared to others. ‘I tried everything I could to hide that I was working class. I spent every little penny I had earned from my parttime job by trying to look more wealthy than I was. At the time, working class meant not having enough and not being good enough. However, I view it very, very differently now. I am very proud of being working class.’ Sustere feels she largely ﬁts in with fellow forensic psychologists thanks to the exhausting task of

camouﬂaging, but also says she can occasionally stick out like a sore thumb. ‘Sometimes it’s too exhausting. I sound quite common, I swear like a trooper, I have a very “say it how it is” attitude, and it generally takes me a lot of time and effort to articulate myself as I live in a constant fear of not sounding smart enough, or using the “proper” words.’ Rickett feels her class is reiterated to her all the time. Being head of a psychology department while also being working class is rare, making her notably different. ‘I have experienced class division and classism, and it’s not really gone away just because I’ve advanced in my career. We continue to be made to feel different because universities are still very middle class – academic working class people are still in very small numbers compared to the students. They’re just not getting through the system.’ Supporting and relating What about the positives of being a psychologist from a working class background? Acknowledging Rickett’s point that being too celebratory could gloss over the

Forensic Psychologist in training Edite Sustere

Clinical psychologist Dr Ben Campbell

inequalities some people face, we did hear about some of the positive impacts of being working class. Blakey’s background has encouraged her to unpick the impact of social inequality on cognitive development. ‘I often think I should have been a sociologist as they have a brilliant grasp on the societal structures and broader cultural factors that may lead to differences and I’m getting more interested in the interplay between psychological factors and the wider context in which they unravel.’ ‘Along with PhD student Ella James-Brabham, Blakey’s research has found that differences in socioeconomic status do not seem to associate with maths learning activities parents do at home. ‘This fits with my experience growing up – although we didn’t have much money and my parents were not university educated, they engaged us in learning all of the time in an informal way.’ Blakey also looks out for any students who are struggling during their first year at university because of their circumstances. ‘I’ve been there myself. If students are late or having a hard time, I try to understand their personal circumstances – are they late because they are running to a seminar from their parttime job? I have had the lovely job of running open days for the department too and have strived to make it a welcoming place for families as I’m aware for some, it may be their first time in a university.’ Dr Laura Kilby, an Associate Professor at Sheffield Hallam University who was born in North London and grew up in North Yorkshire, is also from a working class background and says there are likely some advantages. ‘My suspicion is that you would find amongst people from working class backgrounds that they’re likely to be more resourceful, they’re likely to have a better grasp of how the world works because they’ve probably had to engage a little bit more in things like part-time jobs, or more practical ways of living than their counterparts who are perhaps coming from more privileged backgrounds. And some of those skills and qualities are really, really valuable in university.’ For Sustere, the positives are in being able to relate to clients. ‘The majority of the patients I work with also come from disadvantaged backgrounds, which allows me to connect and empathise with others who may have experienced similar difficulties. I feel like there are a lot of similarities I share with the people I support. This has allowed me to understand the person within their context.’

Belonging and representation The position and title of academics may inadvertently mask working class backgrounds – Kilby says that the many working class students at Sheffield Hallam University may not realise she shares their background. The psychologists we spoke to felt that greater visibility of working class academics would be useful, and Blakey tells us how she enacts this in her teaching. ‘I get to teach first year students and always briefly mention my experience and that I’m available if anyone is struggling with finding their way and wants to chat. I hope it makes any students feeling any culture shock less alone.’ Blakey adds that working class students could be supported by providing access to personal tutors from a similar background, ‘so they can really empathise and understand what it is like especially during that critical first year’. Kilby thinks that psychologists have barely registered the impact of someone’s background on their experience of university. ‘I don’t think we’ve been very attuned to recognising that somebody’s background has a bearing on how they can experience university, how they can experience their studies, where things are challenging and how they experience those challenges. Do they see them as a result of feeling like they shouldn’t be here or do they experience those challenges as “this is really hard but that’s not as a result of my inability to be able to do it” because they come with confidence and a feeling of entitlement. I think as a first generation student at university you don’t have the same sense of entitlement or a feeling of a right to be there.’ Rickett similarly says that there should be a focus on making working class people welcome, and a move away from the sense that they don’t feel they belong because there’s something wrong with them… ‘I think traditionally within psychology we’ve often thought of belonging as residing inside ourselves… But when we’re just construing belonging as our own private emotion – separate from the context that we’re actually living in – it means that we don’t think about how these things can be very organisationally situated and, actually, it’s the organisation that needs to be more welcoming.’ We talk about impostor syndrome as a personal attribute, but ultimately the unfamiliar environment causes that feeling. Representation of working class backgrounds in academia has benefits beyond welcoming new working class students, Blakey says. ‘In research – especially because as psychologists we aim to understand human thought and behaviour – we need researchers from diverse social backgrounds to ask the right questions and come at it from multiple perspectives.’ Those from a working class background may bring new angles and questions to psychology research.

the psychologist september 2021 class

Intersecting characteristics Just as class has largely been neglected by psychology, its intersection with other characteristics has also been somewhat hidden. ‘Class often can’t be separated from other systems of difference,’ Rickett says. ‘I don’t think psychologists have grappled with this and they tend to not really name any demographics – leaving class very hidden, they also do it with race and gender. People from Black and Asian minority groups are more likely to fall within working class communities simply because of the deeper level of division that occurs for them. You see increased disabilities within working class communities for a whole number of reasons. It’s hard to separate these things, it’s multifaceted.’ Kilby agrees. ‘When we explore

the challenges and prejudices associated with class, race, gender, sexuality, age, religion, disability, or any other aspect of a person’s identity (often the protected characteristics) we tend to think about them in isolation, but often these things overlap’. Kilby notices that mature students at Shefﬁeld Hallam are often from working class backgrounds. ‘This presents a potential for complex feelings of “otherness” and an array of challenges for these students who are operating in really unfamiliar territory, often having to get to grips with new learning technologies and surrounded by people half their age.’ ‘Similarly’, Kilby says, ‘I work with working class students from minoritized racial or ethnic backgrounds. These students have to manage all of the challenges

Having the conversation One way to improve things for working class people is simply to talk about class, Kilby suggests. ‘I think we’ve got to be willing to have the conversation. We’ve made class invisible because what we’ve said is, no matter what your background you’re welcome. On an explicit level we’ve said well these are the entry requirements and you’re welcome to come, but actually what does welcome feel like? Welcome is a discourse, welcome is an environment, welcome is our practices at university, and I don’t think we’ve really looked at those as closely as we need to, to ﬁnd out what it would mean to feel welcome if your background was one where this environment is completely foreign. How would we

Dr Laura Kilby, an Associate Professor at Shefﬁeld Hallam University

associated with the elitism of university alongside the multitude of racial microaggressions that impact daily life, as well as balancing racial and/or cultural differences that are often not well understood by their White peers and tutors. Added to which they are largely studying a curriculum and experiencing teaching styles that lack diverse cultural or racial representation, and they are largely taught by White faculty.’ Campbell sees the intersections between conversations on class, and the conversations on racism and antiracist practice over the last couple of years. For him, the starting point is acknowledgement and recognition of the barriers. ‘I don’t think those are easy conversations to have. They require really harsh, honest truths about privilege.’

know what welcome feels like if we’re not talking to people about that?’ Clinical psychologist Dr Ben Campbell, who grew up in Belfast, works at Antrim Hospital A&E and has been running webinars with Curvis to talk about class in clinical psychology and related issues including disability and race. Campbell says it can be tricky to have conversations about class in a professional context, but that it’s especially important at the pre-qualification stage. ‘I think naming it as a thing is really important, a lot of this goes unspoken... I think there’s value in bringing it to people’s attention first – until you do that you can’t do anything to change it.’ Sustere used to hide her working class background, but now realises ‘there is nothing to embarrassed or ashamed about’. She also thinks that students should have these conversations – ‘I’d encourage them to speak about their backgrounds proudly and ask for help where needed’. Talking about class can be difficult, and not just for those from a working class background. Curvis says that in the webinars he’s been running with Campbell, they ‘didn’t want it to be an unpleasant place for somebody who was quite posh’. They wanted everyone to be able to hear the conversations. ‘We didn’t want it to be a them vs. us conversation because no-one chooses where they’re born, no-one chooses the family they grew up with… It’s not helpful to have it as a narrative where it’s “they had all the privilege

and we’ve had none” – that doesn’t help anyone, it’s not true and it’s not meaningful. We all need to take a bit of responsibility for reflecting on our own privilege and the barriers that we face. I think we need to do that in a joined-up way so that people can learn from each other.’ Institutional change University staff often assume that students arrive with writing and research skills, and that they know how to cite evidence, what journals are, how scientific knowledge is built, and what opaque terms like ‘office hours’ mean. These are ‘the rules of the game’, Blakey tells us, and they need to be made explicit. ‘I think students struggle with what we call the hidden curriculum,’ Rickett says, ‘the idea that in universities often it’s assumed that students know what we’re talking about when we use language around universities when they might not have anybody in the family who went to university or do not know anybody who went to university – I certainly didn’t’. Universities increasingly organise widening participation activities, which Blakey thinks are often well meaning but can be tokenistic. ‘I’ve seen events where teenagers are invited to a talk and buffet lunch with academics at university and are surprised when many inevitably don’t show. Of course they won’t – I wouldn’t have! It’s too daunting and out of touch with their experience. Universities need to support academics in going into schools early on to give engaging talks and become familiar faces in our local schools. We need to become more part of the community.’ Psychology courses and posts may not be accessible or supportive enough for working class students. ‘Some doctoral courses might want to look at their selection and think about how accessible they are,’

Join the conversation If you have been inspired by the experiences shared in this article and would like to join the discussion, Campbell and Curvis are running ongoing webinars discussing class in clinical psychology – they can be found on Twitter @classclin. A recent position statement released by Campbell, Curvis and colleagues explores some of the insights and themes gleaned through these webinars and can be downloaded via the @classclin Twitter page. The Association of Working-Class Academics, an international organisation which runs webinars and publishes news and resources for working class academics, can also be found on Twitter @ AWCAcademics or at www.workingclassacademics.com. The British Psychological Society’s Presidential Taskforce on Diversity and Inclusion has also run a number of webinars on the topic, including one on class, which you can watch here: tinyurl.com/7n5zscax 40

Curvis said. ‘I struggle a bit with some of the rules that some courses have in place, and the mechanisms that they use to select trainees off the basis of a form.’ Campbell adds that universities should change how posts are advertised and put support structures in place. ‘Working class people don’t have the same protection or containment in the way that someone from a more privileged background might have. I think if there was recognition of that first of all and maybe something in place just to hold people, and guidance along the way, I think that would be really, really helpful.’ Sustere thinks universities should ‘create a space for students to practise vulnerability’, through mentoring programmes or peer support – and advertise those processes so that they are well known. Beyond the conversation Even those psychologists from a working class background who do thrive may not always find it easy. Blakey says that she still finds academia alien in many ways. ‘It’s competitive, frequently individualistic… I also found the whole concept of networking odd – of having these forced seemingly inauthentic interactions where you hope to gain something.’ Campbell says he felt pressure to sanitise his way of talking and behaving. ‘I think when you pick up on that it’s a wee bit exclusionary, or it reinforces that disconnected feeling of “I really should not be here”. Some of the themes from the webinars have reflected that – how people speak, how people dress, the food that they eat, whether they drive or not, where they live, all that kind of stuff is all going on underneath the surface, all the time, and that’s definitely the case for me as well.’ But these conversations alone are not enough. They need to be followed up with action, Campbell says. ‘I think there’s a lot of really fantastic people who want to get into the profession, and are highly motivated, and would bring a really interesting perspective into training and qualified life but it’s those who tend to drop off because they can’t dedicate their time for free, and they can’t network in a way that would maybe facilitate them getting on the training.’ The psychologists we spoke to expressed a sense of duty to improve the environment for working class students. ‘If we’ve got really bright students that come, despite probably a lot of adversity and lack of resources and support, and they don’t leave with brilliant outcomes’, Rickett says, ‘then I think we’ve really let these students down’. Psychology is well placed for going beyond the conversation. As Campbell tells us, ‘psychology as a profession is maybe best suited to be the one to reflect on themselves, have a look at how they’re doing things and make some meaningful changes’. Improving the environment for working class psychologists will need top-down support and institutional change. Opening up the conversation on class is just the first step towards positive action.

Under the auspices of:

Psychology: Uniting communities for a sustainable world 3–6 July 2023, Brighton Centre

Scientific Committee – call for members We are looking for a group of practitioners and researchers united by their energy and passion for psychology. We appeal to people from across all domains of psychology to come together in ensuring a dynamic, innovative and far-reaching scientific programme that reflects a blend of knowledge and experience representing the best of psychology. The theme of uniting communities requires psychology to build strong collaborations across borders between academics and practitioners alike. The role of the committee includes: •

The responsibility for managing the scientiﬁc programme, including call for submissions, and decision making on selection of submitted abstracts and presenters.

•

Ensuring diversity and inclusion in all aspects relating to the scientiﬁc programme, including consideration of technology, accessibility for submissions, presentations and participation.

•

Encouraging wide participation from psychologists from different domains and regions.

•

Ensuring that the type and form of the congress programme promotes sustainability. For example, the call for submissions for an e-poster system which will replace hard copy, ensuring that participation in the conference is possible virtually to its greatest extent.

Applications are welcomed from across the membership – including academics, teachers, researchers and practitioners. We are also seeking undergraduate, postgraduate and early career members to ensure representation at all stages of the career pathway. The Society encourages applications from the following groups of people who are under-represented within our committees: Black, Asian and Minority Ethnic people, people with disabilities, and people who identify as LGBTQ+. We welcome all people who have the potential to help humanity in solving the problems that our world faces today.

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‘The person becomes the universe of exploration’ Astrid Coxon meets Jonathan A. Smith, recipient of an Honorary Fellowship of the BPS, best known for his development of Interpretative Phenomenological Analysis

You were recently made an Honorary Fellow of the British Psychological Society: what was your reaction to this news? I was taken aback in a sense… it’s an award of such high standing. Previous winners include some of the people who I was most drawn to when I first came into psychology… Jerome Bruner and Ulric Neisser, for example, were pretty influential on me in terms of the way they did psychology. What I’ve done since is very different, but it’s nice to see that line of continuity. It’s a mark of recognition for the importance of qualitative psychology within that long psychology tradition. So where did your personal journey into psychology start? My first degree was English literature. I soon realised that a lot of what I was drawn to in English literature was actually the psychological constructs. I wrote dissertations on perception in the poetry of William Wordsworth, and social interaction in the plays of Harold Pinter, for example. When I finished, that didn’t go away. I still had that yearning. I worked in publishing and journalism, and then went to Sussex to do a conversion course in psychology. It was an exhilarating time. I think there’s a surprising number of people in psychology who didn’t start in psychology. They come from all over the place… that’s quite a hallmark of psychology. There’s something in common at the heart of it, but it’s also a very broad church. Psychology can usefully draw on skill sets from a wide range of other places.

Yes, my own background is in philosophy, and I hear this story from quite a lot of colleagues – they started in different ﬁelds and transferred over. Tell us a little bit about IPA, Interpretative

Phenomenological Analysis. What was your initial inspiration to develop this approach to qualitative research? It’s a strange process, looking back, a bit scary as well… you realise how long you’ve been doing this! I started my DPhil in Oxford. I felt I had the freedom to explore a range of different ideas… in some ways psychology was less compartmentalised in those days. While IPA has developed a life of its own, it started in a much more modest way. I didn’t set out to develop a methodology that was going to be very successful in psychology; I set out to solve a problem, which was doing my PhD. I was interested in personal experience, and the meaning that experiences hold for participants, the way identities transform across the life course. When I looked at most of the methodologies that were available for psychology at the time, they did important things, but didn’t really work for the question that I was interested in. The prior experience that I had, academically and professionally, gave me conﬁdence to do what I wanted to do. I knew I had important issues that I wanted to look at: I’d given up a career, in effect, to do that. I had a heavy investment in it. I was going to make sure that I actually did what I wanted to do. I looked around at what was available, and drew on ideas from phenomenology and symbolic interactionism. I was fortunate to come across Rom Harré, who became my supervisor at the time, and he was in philosophy. He introduced a whole other ballgame, both fairly classic philosophy in the philosophy of identity and people like Locke and Hume. But also I was very drawn to his writing around personal accounts, the meaning of these things to participants and the importance of the single case. So I mixed a rich brew of interesting ideas and brought them together into something that worked.

the psychologist september 2021 interview

What IPA was becoming was something theoretically grounded, conceptually rich, but also that would enable us to do psychology, empirical in the broadest sense, collecting data from participants, analysing and presenting that material in a systematic way. What are the particular hallmarks of IPA as a qualitative approach? There’s now a complex nexus of different qualitative approaches… a fuzzy set of similarities and differences. Essentially, a key facet of IPA is our commitment to looking at experience – the sense-making that participants are doing around important things that are happening to them. We’re not looking at some notion of a pure experience, whatever that would be… it’s what the things mean to participants. I invoke the term ‘double hermeneutic’, which is a bit of jargon, I guess, but to speak to the fact that this is a heavily interpreted process, it’s interpretative at both ends: the researcher is trying to make sense of the participant trying to make sense of X. The most distinctive feature of IPA is idiography – a strong commitment to looking at each case in turn.

The person becomes the universe of exploration at the outset. It’s a matter of staying with this person, or this family or this small institution. You do a detailed analysis of what’s going on, the connections between the important resonances for that person. It’s only after you’ve achieved some sort of partial closure on the ﬁrst case that you move to the next one, and then the next one. This is painstaking, it’s slow. But if it’s done well, it’s an analysis that speaks to some sort of convergence, some sort of patterning across individuals, but at the same time, the idiosyncrasies they make manifest. If you look at that constellation, the different sets of ingredients and the way they’re marked… that’s what sets IPA apart from other approaches. What do you think gets overlooked when people start doing IPA? Quite often with qualitative research it can seem deceptively straightforward. It’s a bit of a cliché now, but the story used to be that students are drawn to qualitative methods because they don’t like doing statistics. Qualitative research is just as hard as quantitative research, it’s just hard in a different way. The personal demands on the researcher as agent in

Jonathan A. Smith is a Professor of Psychology at Birkbeck University of London. Dr Astrid Coxon is a research associate and teaching fellow, working part-time in the Education Support Team, IoPPN.

doing qualitative research – any qualitative research, but IPA in particular – are very great. The biggest part of doing qualitative research, and IPA in particular, is the analysis. That’s what takes the time. That is what enables you to present an account to an audience. However, the quality of the data you get sets a cap for the analysis that you can do. You may talk to somebody for an hour. But it’s the quality of what happens in that hour that determines the days of analysis you do later, how rich and how far that can go. Getting good data from participants is a skilful activity, but it’s not magic. It’s something that people can acquire. Some people take to it more readily than others, and I spend a lot of time on that with my students. So the analysis can make or break the IPA, but you need good data to start with. Let’s talk about your pain research, what makes that well-suited to IPA? Pain is fascinating, it’s elusive. It’s affected by so many different individual and contextual factors, and each quantitative instrument only gets at one aspect. For a long time, a lot of papers would finish by saying, ‘well, pain’s personal, and we need to know more about that personal experience’. That’s where the research finished rather than started. And what is good is that more recently we are finding research that starts there, which begins by asking people for their own personal accounts of the experience of pain. Pain is an experience that knocks people over, but that’s often not recognised. That takes a lot of getting at. If you do sit with somebody, and you get them to start talking about their pain, then rich accounts come out that weren’t necessarily anticipated. We got extraordinary data and some of that still powerfully affects me now… for example, paraphrasing a participant, ‘if it was just the pain, it would be okay. It’s actually what it’s doing to my head. That is the worst part’. It gives an inkling of a whole other story… it’s not just about physical symptoms, it’s more the way it’s impacting the person, an unsteadiness, the way they think they’ve changed from the person they were before, an unreliability, sense of shame and stigma that comes with it. There’s a whole series of other very psychological things that are happening when you start to unpick pain.

So much more than can be measured on a scale… Could you tell me about the more recent research you’ve been involved in? We have a whole series of different topics we are investigating. I am working with Roz Shafran (UCL) on a mixed methods study examining the effectiveness of a modiﬁed CBT intervention for young people with epilepsy and psychological difﬁculties. I am collaborating with researchers in India on how COVID-19 is affecting participants’ experience of work. A key role in my career has been articulating a way of thinking about psychology. I’ve applied that in so many

different areas. I didn’t know how conscious that was… probably at some point, it did become conscious, I wanted to show this was a universal approach, rather than it being pigeon-holed as ‘IPA is for research on X’. You can keep expanding the areas it applies to. For example I’ve got PhD students doing projects on: art perception; the impact of divorce on the sense of self; being an actor; and the different mood states in bipolar disorder. There are developments I’m particularly pleased about… multimodal things, expanding IPA, for example using it alongside pictorial representations, so that participants create a visual record at the same time as taking part in the interview. Visual methodology is quite a big thing in the social sciences now. In the pain research, starting with work with Jamie Kirkham and now with my PhD student Isabella Nizza, who asks people who are taking part in a pain management programme to draw their pain, and then talks to them about their drawing. These are not artists, but the images they come up with are incredibly striking. And the drawings trigger other thoughts: people tell a very interesting verbal story of their pain, prompted by the drawing. It’s a longitudinal approach too: we’re watching the change in their pictorial representation, and in their account of pain as they go through the programme. You sound particularly proud of that work… what would you say has been the most challenging research you’ve been involved in? The challenges are both particular and constant. Every interview you do, every person you work with, is a new event. To each of those encounters, you bring the experience you have, and some growing conﬁdence that things will work. However, one’s always surprised by the person who talks in a different way, who needs particular help in order to begin to feel comfortable to disclose their particular experience. In a way, maybe it’s surprising that I can still be surprised! These things are so ﬂuid, so liminal. A lot of my research is on heavy duty things, major life transitions, threats, projects that have existential importance. Then we might research something that seems much less challenging for the person – we’ll encourage students to do something on a positive experience. But then you realise even something that seems relatively straightforward, for a particular person it triggers something… they can get quite upset by something you wouldn’t have expected. One of the biggest challenges in the early days was getting qualitative research and IPA published… dealing with brusque statements about everything that was wrong with this sort of research… but persisting. That has changed a lot. There’s an increasing number of journals with a track record for publishing qualitative research, but there’s always others that still need to be persuaded. Do you have any advice for early career researchers

the psychologist september 2021 interview

Classic! approaching journals with qualitative papers, or Where you would like to see IPA going: how it responding to reviewer comments? might develop, future applications? The process of peer review stays constant throughout There’s been this fairly recent development of more one’s career. I’m a well-established psychologist, I still complicated designs, for example multimodal where have to go through this process, I still get the bruising one collects data in different forms… the visual rejection slips. It’s devastating when it happens to representation I talked about, and Johanna Spiers you the first time, but remember that’s the academic did some work looking at interview data alongside process. You’ve done your research, you’re proud of it. But it poetry. Then there’s a growing amount of longitudinal research… the irony there is that my PhD was doesn’t stand in isolation. If you want people to know longitudinal, then I just got caught up in a whole raft about it, you’ve got to work out a way of making that of other things, and now it’s being picked up again, and available. Look at relevant journals and do searches in other people are taking it forward. terms of what qualitative research they’ve published At the same time, it’s important we don’t just follow before. Journals aren’t static, editors change, and that’s fashion. I would not want everybody to be doing both frustrating but exciting that a journal could have been going for a long time and been quite conservative, multimodal longitudinal studies. People should still do pure and simple IPA, just talking and suddenly there’s a change of to a relatively small number of regime and they’re open. Take people about their experience and advice from people, in terms of “…I get a stinging review recording it and analysing it. supervisors and other people, and that says ‘you haven’t done We want to see both the simple look at look at where journals and the more complex working are currently, in terms of their this as Jonathan Smith receptivity to qualitative research. says it should be done’…” alongside each other. In the early days of being an For me, quality not quantity academic, I felt I had a handle on is important. We might have all the qualitative research that was collected data from a range of being done… the latest take on discourse analysis, participants and got a series of phenomenologicallyI could be aware of that alongside IPA and other things. informed experiential themes. If we present all of that Now, I can’t even keep on top of the IPA. In one sense, in the 5000 words the journal makes available, it’ll be that’s great. There’s a lot of IPA being published and a superficial… just a taster of each of those. It’s quite legitimate to say, ‘we’re going to present this part of the proportion of that is very good. But there’s quite a lot that’s only okay, mediocre. I have mixed feelings about data for this journal. We’re going to show you at full that. Partly I feel frustrated: I look at papers that have length what it’s like for these participants, we’re going the potential to be much better, and I think ‘why didn’t to give you enough extracts from enough participants they do this?’. The other part of me is more charitable. to show you the convergence and the divergence. I’ve Many people are doing IPA and qualitative methods got another paper, which is drawing things together, on their own. Qualitative research is personally and maybe that fits in a different place.’ So you’re demanding, you need guidance and mentoring. seeing IPA at its best. I don’t like journals which say Recently I’ve tried to help that process through, for ‘you can publish your qualitative research, but you example, writing papers showing what good work have to have the five extracts in a table separate from is, how to evaluate IPA and making useful material the narrative where you present your interpretation’. available on the IPA website. So one of my hopes for That doesn’t make any sense to me. the future is that gradually, the proportion of IPA that is In terms of dealing with reviewers, I think be good and excellent increases. I’m sure it will. straightforward and honest. There’s not an expectation The other thing is mixed methods research. that you have to do everything. You can have this Historically, qualitative research has often needed to whole litany of points made by reviewers, but what establish itself in its own terms, rather than being the journal editors are looking for is integrity and effort. If younger sibling of the quantitative research. Now it’s you’ve made changes, and specifically articulated what more established and more mature, the next phase those are, be patient and be robust. Over time, a lot of for IPA and qualitative research in general is working papers will find a home. Somebody will bite, and the paper will be improved through the reviewing process. alongside quantitative researchers as equals. When I look at mixed methods research, on the whole I don’t think it is yet exploiting the full Perhaps we should feel reassured that even at this potential of what the qualitative can bring to it. Human stage in your career, you feel that wounding of being phenomena are complex. We will understand those rejected? phenomena better if we are thinking about designs Every so often I get a stinging review that says ‘you which go across, which link different qualitative haven’t done this as Jonathan Smith says it should be approaches together, and are linking qualitative and done’, and I have to go and read up on how to do IPA quantitative methods in more powerful and integrated properly, according to Jonathan Smith! That always ways. gives me a wry smile.

‘With AI, we’re amplifying the powers of the clinician’

I Dr Ross Harper

Dr Ross Harper on his journey to CEO for Limbic, providing AI software for mental healthcare

come from a background in neuroscience and mathematical modelling. I started my academic life at Cambridge University, studying natural sciences and majoring in neuroscience. I quickly became fascinated with how the brain works. After my undergraduate degree, I started to think about how I could further my understanding of the brain and neural networks. I began to believe that solutions to some of the biggest challenges in mental illness would come from computational approaches, rather than cutting up brains in a laboratory. At the same time, computational neuroscience was gathering momentum. I decided to do a Master’s in Mathematical Modelling at University College London. During this time, I learnt to code and construct mathematical models, but most importantly, I learnt to think like an engineer. This led me to a PhD in Computational Neuroscience. My thesis focused on the mechanisms of biological timekeeping within circadian networks of the brain – I was able to apply statistical methods to studies of the brain and combine my academic backgrounds. As much as I enjoyed the world of academia and research, I began to feel as though academia was losing its monopoly on cutting-edge research. Scientiﬁc breakthroughs could happen outside of universities. Companies like DeepMind, for example, had spun out of UCL and were leading the way for innovation in their ﬁeld. From a personal standpoint, I also learnt that I work best when I’m able to have an immediate impact, so the world of startups and private research became very attractive to me. It was then that I joined the Entrepreneur First accelerator programme with an idea for an AI-based approach to mental healthcare. I found my co-founder and programming whiz, Sebastiaan de Vries, and together we started Limbic – the brainchild of our backgrounds in neuroscience, mathematical modelling and software development.

New problems to solve Fast forward three years and we have a team of eight people – with backgrounds in AI, mental health,

product development, software, operations, sales and marketing – working to achieve better outcomes for mental healthcare. I’ll come on to how, exactly. Our software has now been deployed in four Improving Access to Psychological Therapies (IAPT) services and our tight-knit team has pulled together through a global pandemic that has highlighted the need for greater efficiencies in mental healthcare. We’re constantly evolving and learning, always faced with new problems to solve. With so many different specialities in our team, on any given day we could be giving a product demo to a potential partner, interviewing patients for product feedback, developing clinical risk assessments, consulting our wider network of clinicians, developing mathematical algorithms and new product features, or speaking to investors. As such, my time is largely spent catching up with various members of our team on Slack or Zoom about their progress and supporting them to achieve our collective objectives. They say crisis breeds opportunity and, in many ways, we have Covid to thank for the progression in mental healthcare in the last year. The conversation has shifted, reducing some of the stigma. Mental health is getting to be as high-up on the national agenda as Covid-19 itself. This is reflected in large initiatives like the NHS Long Term Plan, and has increased competition in the space, which can only be a good thing. I’ve seen a wealth of new companies entering the consumer wellbeing and employee wellness markets, focusing on preventative mental health. A supply and demand mismatch 1.7m patients entered talk therapy services in 2019. That number is expected to grow significantly in the wake of Covid-19, yet service capacities are not expected to increase anytime soon. Fundamentally, we have a supply and demand mismatch in mental health. Digital solutions will no doubt play a role in bridging this gap, such as enabling clinical triage at scale. Psychological therapy is a very human-centric discipline. This presents another challenge for digital innovation. AI and machine learning have been adopted in many other areas of healthcare, but mental health is different. Arguably, of all the health sectors, psychological therapy requires the biggest human

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touch. How then, do we integrate digital solutions into a discipline that is fundamentally based on human relationships? That’s why I believe talk of full automation within this space is naive and short-sighted. At Limbic we focus less on replacing therapists, and more on augmenting them. Our software seeks to solve specific pain points in the clinical pathway. We are able to keep healthcare fundamentally human and personalised, while also freeing up clinical hours wherever it doesn’t make sense to use valuable human resources. We’re amplifying the powers of the clinician. Easing pain points Around 25 per cent of the total IAPT budget is spent on clinically assessing new service users. These assessments are notoriously labour- and adminintensive. Typically, the process involves a one-hour phone call to screen the patient for service eligibility, assess risk and point them to the most appropriate care pathway. We identified the clinical assessments process as a pain point early on and looked at ways to augment this through ‘Limbic Access’, our self-referral software. Our conversational AI chatbot engages with the patient in natural conversation, asking key questions that would typically be asked by a healthcare professional, thus freeing up staff resources and accelerating patient access to support. The Limbic Access platform enables services to automatically pre-screen incoming referrals and either signpost to alternative services or identify an appropriate treatment pathway within the service. I believe the results speak for themselves. Within one month of deployment in four IAPTs, the platform saved 20 minutes per referral, 430 weeks of patient waiting time, and 86 clinical hours. Not only did feedback show that patients benefited from a more interactive and engaging experience (92 per cent said the tool helped them access care), but nearly half of patients (41 per cent) accessed the service outside of regular working hours, at the height of their helpseeking behaviour. So, as well as increasing efficiencies, technology can also reduce barriers to access. Once the patient moves to the waitlist, Limbic Access evolves into a mobile app called ‘Limbic Self-Care’. It enables services to deliver homework exercises, for example, mood journaling and thought diaries, and also provides the patient with validated CBT strategies 24/7 while they wait for treatment. By leveraging wait times as an opportunity to gather key information, Limbic can share this with an assigned clinician to facilitate faster progress when treatment commences. Once treatment begins, the app becomes a means of remote symptom monitoring between sessions. The clinician is able to coach Limbic on how to deal with their patient between sessions and provide personalised coping strategies to help the patient in the real world. I believe this approach reiterates our thesis

that human clinicians must be amplified – taking their expertise and using it between sessions and across the patient journey. Psychology will always be human In many instances, our platform relies on data from clinicians. Limbic Self-Care and Care are both designed so that the clinician acts like a coach. The clinician feeds data about the patient into the platform, which provides more personalisation between sessions. If a patient is struggling out in the real world, for example, the platform refers to coping strategies that have been provided by their own clinician. In mental health, every patient experience is unique. While some clinicians are rightly concerned about poorly-evidenced wellbeing apps masquerading as replacements to therapy, Limbic always asks the clinicians to input their expertise on how best to treat their patients. With Limbic Access, a key result is to achieve triage at scale to support the supply and demand mismatch. Again, our goal is to improve access to care – not replace clinicians with a digital alternative. Enabling triage at scale is just half of the battle though. A product is obsolete if the end-users don’t want to use it. This is where a lot of healthtech startups go wrong; too often, there’s a gap between the theory and the outcome. Clinical validation and user feedback are critical across all healthcare sectors to ensure the product at hand can integrate seamlessly and provide true value to the service and patients. Supporting frontline workers As a company that works with NHS providers, we know first-hand that more needs to be done to support the mental health of frontline workers. In the mental health profession alone, over one in ten posts are vacant and 2000 staff quit their jobs every month. Digital innovation can play a role in helping to reduce staff burnout, and we’ve adapted our product to serve this audience as well. We need to ensure our product is easing clinician workload, not adding to it, and our team spends a lot of time looking at how we can instil positive feedback loops in our software – helping both patients and clinicians build habit loops. We believe this is key to driving true uptake and delivering value. Constant feedback from clinicians working within IAPT services ensures we’re developing a product that people genuinely want to use. We have to be sure it’s doing what we intend it to do – to increase efficiencies, speed up patient access to support and augment the powers of clinicians. This sort of clinical validation is vital, and I would love to see more of a collaborative clinical approach in mental healthcare. We need the industry to come together as soon as possible to ensure that everyone has access to the right support when they need it.

‘Intercultural competence is a very important part of psychological literacy’ Intercultural Competence for College and University Students: A Global Guide for Employability and Social Change by Dr Caprice Lantz-Deaton and Professor Irina Golubeva is out now. Jon Sutton asked Caprice some questions about the book. What motivated you to write a book about intercultural competence? Just like a lot of people, I’m a bit of an idealist and I want to make a difference. Promoting understanding between people of different cultures is my area of interest and I think it is, and always has been, important for societies. Whether we know it or not, a lot of conﬂicts across societies have to do with clashes of culture. Whether it be differences in nationality, race, sex, religion, politics, socioeconomic status, or some other group difference – any cultural difference can result in friction between individuals and groups leading to everything from simple misunderstandings to extreme and large scale acts of violence. A lot of psychologists study intergroup conﬂict which is certainly useful in understanding such friction. I think intercultural competence (IC) is a more practical but sorely neglected means of trying to positively address cultural difference. If we teach IC more widely, we can help to foster the development of graduates who are better prepared to engage positively with those who are different from themselves. This is the aim of the book – it is designed as a guide for college and university students in any discipline and in any country to explain, and importantly, help them to develop, IC.

Probably some readers won’t know what IC is exactly. Can you explain it? That’s tricky because there are more than 160 definitions of just the word ‘culture’, never mind IC, and the term itself is contested. There is a chapter in the book dedicated to explaining culture and another to IC so it’s impossible to answer in just a few words. In the book we encourage students to analyse different terms and definitions rather than giving a definitive definition. But one that we like is from a fellow psychologist, Professor Martyn Barrett, from the University of Surrey. He defines it as a collection of ‘values, attitudes, knowledge, understandings, skills and behaviours which are needed for understanding and respecting people who are perceived to be culturally different from oneself; interacting and communicating effectively and

appropriately with such people; and establishing positive and constructive relationships with such people’ (2013, p.52). There are over 300 components that researchers suggest define IC. We think the most important are selfawareness, respecting and valuing diversity, openness, curiosity, empathy, adaptability, critical thinking and humility. While developing such values, attitudes and skills might come as a matter of course for some people because of personality traits and/or life experiences, for many they must be learned over time and with practice. In the book we suggest ways that IC can be developed – and that’s not just through study abroad which many people tend to think. Yes, as you said, people do tend to think such topics are only relevant to study abroad. How does the book address this? Study abroad can be a good way to experience cultural differences and potentially develop IC. But study abroad programmes are not created equal and do not all cultivate IC in students as well as they could. Also, study abroad tends to be for well-heeled students – so maybe 3 per cent of all students - but what about everyone else? We tend to emphasise on-campus activities. Domestic diversity is typically overlooked as a means to learn about and experience cultural difference. So, while we do recommend offices of study abroad and internationalisation in terms of providing avenues for students to develop IC, we also discuss offices of Equality, Diversity, and Inclusion (EDI) which can be equally valuable. While there are certainly differences in their remits, IC comes down to understanding and relating to people from different cultures, whether they are from different countries or simply different cultural groups within countries. Because of the practical nature of the book, we not only advise students on where they might go to find help with developing IC, we encourage them to become activists in a way. Although few UK universities have IC related initiatives, in many countries there is nothing on offer. So we suggest that students take a variety of actions

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to get things going: start an IC society or culture club; ask their division or university to initiate an IC certificate program; ask their division head if IC can be embedded in the curriculum or included as an optional or required module (of course we think it should be required for all students!). Since you are writing for psychologists here, can you address the relevance of IC for our discipline? Psychologists have so much to offer in terms of defining IC, and the book brings in a lot of background research from social psychology particularly. While a few psychologists seem interested in IC specifically, there don’t seem to be many, so I think we need more psychologists who are interested in contributing to this important area. Psychologists also have so much to offer in terms of teaching IC. While it can and should be taught in any discipline, it is easy to fit into psychology because it is so relevant to understanding human behaviour and relationships. Why is it not part of every psychology curriculum? I do think it is one of the most important topics of our time and it is just not well recognised within or outside of the discipline. IC is a very important part of psychological literacy – which is highly touted, at least in the UK, as being part of what the study of psychology offers students as a nonvocational degree course. If it is so important, it needs to be more integrated into our teaching. You make the book sound as it is more about creating a more peaceful world, but the title also mentions employability. Could you explain the emphasis on employability? I wanted to write this book to promote understanding between people from different cultures. It’s what I studied during my PhD and what I most enjoy teaching as a lecturer. But it made sense to address IC in employability terms for quite a few reasons. While some students are idealistic like me, others are more practically oriented and are worried about finding a job. Fair enough! Making the world a better place and employability can and should be more joined up and this book does that. With the rise of the global marketplace and domestic diversity, employers are increasingly looking for

graduates who can work effectively across cultures. This book helps students to develop skills that are valuable to employers. We also have a lot of problems with prejudice and discrimination across societies leading to workplace inequalities. For instance, statistics clearly demonstrate that horizontal and vertical segregation are still problems for women and people from BME backgrounds. Part of IC, in our interpretation, is learning about why these inequalities exist and how to address them. Applying knowledge about inequalities can not only help students succeed at work but support them in reducing inequalities and transforming the workforce. This serves a humanistic goal and is a benefit to employers in terms of productivity and profits. Finally, IC is highly relevant to employability related modules and courses so, by including it as a primary aspect of this book, we are hoping to appeal to career educators. IC sounds challenging, maybe even for academics. What is your personal experience with developing IC? I routinely ask students, ‘can you ever be completely interculturally competent?’ Although you can improve aspects of IC such as your ability to apply critical thinking skills, suspend judgement, be open to cultural difference, be flexible and empathetic, there will always be occasions where you could be confronted with a cultural difference that you are unfamiliar with and you will struggle. I’ve been studying IC for years but I still have more learn. That’s humility and that is part of IC. I think this is an important point for academics to keep in mind. Just because you have a PhD and teach students every day, doesn’t mean you are interculturally competent. Undoubtedly, there are some academics that have higher levels of IC and some that have lower levels – it’s a spectrum really. I include examples in the book from students displaying IC as a reality check for all of us. Educators are only human, make mistakes, and have more to learn and sometimes the best teachers can be students. I learned a lot from my students and from writing this book and I hope it will be useful not just for students, but for academics who are interested in learning more about their own IC and how to apply it in higher and further education.

Resisting psychology’s boxes Selﬂess: A Psychologist’s journey through identity and social class Geoffrey Beattie Routledge

Geoffrey Beattie charts his formative years as a working class lad growing up in Belfast, experiencing all the mundane, yet very real challenges of working class poverty – damp rooms, sharing beds with siblings and a tin bath hung on the wall. The writing has a warmth and a gentleness that invited me in. At the same time, my mind kept turning over the question – ‘who is this book for?’ As the book progresses, Beattie weaves in psychological insight with an enjoyable eclecticism. Gradually he merges and illustrates his own story with psychological narratives that hop from Freud to Skinner, to Chomsky, to Goffman. There is no attempt to persuade the reader of any single or linear ‘truth’, quite the opposite. Often, he introduces theorists or insights in a manner that juxtaposes what psychology might tell us about the human condition, opening a space for the reader to ponder some psychological truths that shape our lives. Beattie narrates how he increasingly questioned some contemporary views in cognitivism and linguistics within his developing career, signalling that it’s okay to resist the boxes psychology might put you in. The book increasingly meanders back and forth as Beattie reﬂects on his youth, his family and his working class origins, and re-examines his sense of self, his

relationships and what it means to be a person. He shares some deeply personal experiences including the sudden death of his much-loved older brother Bill, and the shocking accident which saw his lifelong partner Carol lose an arm. I increasingly noticed personal and professional parallels between Beattie’s story and my own. We share a professional concern for language and communication; he spent much of his career in Shefﬁeld, the home to most of my professional life; and he tells a wonderful story about research that took him to a small village near the rather forgotten port town of Grimsby, the region I live in and a village I know well. Beattie reﬂects on the complex relationship with his mother that does not end with her death. He tries to make sense of who they are in relation to one another and

how social class plays in to that complexity. He shares some painful conversations that he had with her and the feelings he was left with after she died. These stories are so familiar to me that it took my breath away. Perhaps it is just me, but I suspect people from working class origins will readily relate to these experiences and complex emotions. Instinctively, I didn’t expect much when I realised this book was written by a TV psychologist with a highprofile public persona. My working class origins make me suspicious of the power that comes with such fame, and my academic snobbery makes me determinedly unimpressed by it. I am revisiting those prejudices! In places, I think the book holds back, and it did not transform my thinking, perhaps because we have a similar worldview. I’m still not sure quite who this book is for, it seems to fall somewhere between audiences, but I hope people find their way to it. We need more books like this – where the author is authentically written in to the work, and psychology is opened up, inviting people to explore it in relation to their own lives, rather than seeking to open people up to psychology and asking them to understand themselves in light of its knowledge. Reviewed by Dr Laura Kilby, Associate Professor, Sheffield Hallam University

Neuroscience and Buddhism come together

Rick Hanson, a neuropsychologist and Buddhist, ably brings together current understandings of brain functioning with ideas for improving the mind honed over centuries. He maps a journey up a mountain towards his version of increasing enlightenment. For Hanson, that’s a calm, steady mind, ﬁlled with warmth and compassion towards self and others, with an inclusive sense of ‘us’. The enlightened mind, according to Hanson, also understands its place in the world/ universe, is imbued with a sense of wholeness, interconnectedness and timelessness, is released from personal craving, and is reﬂective and enquiring. Hanson outlines a Buddhist-derived ethical

framework of not harming others: wise speech, wise action, wise livelihood. However, there are various unexamined uncertainties. A calm, steady, warm-hearted, compassionate mind can help with individual problem-solving, but how might it impact our wider systems and decrease suffering? Without collective community elaboration, leadership skill and commitment to our common wellbeing, one risk of this approach, I believe, is an increased narcissistic preoccupation with our own minds, our own happiness, and our own understanding. Read the full review by Dr Marilyn Aitkenhead online

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The importance of friends We all know that friendship is important. The lack of physical social contact with friends and family over the past year has highlighted how important it is within my own life. The science behind friendship was not something I had previously thought about – that all changed when I embarked on this literary journey with Robin Dunbar as my rudder. Dunbar, an evolutionary psychologist by background, eloquently summarises his research of several decades. He looks into our social relationships both past and present, considering how we existed within tribes. Dunbar’s number, he argues, is the number of social relationships we can tolerate cognitively – around 150. Friends collates theory and research including neuroscience, genetics, biology, anthropology, evolution, and animal studies. It is a fascinating insight into the evolution of humanity, the impact of technology on our social relationships, gender differences in friendships, how friendships change over time, and the role that family plays in our external friendships. We are bombarded with threats to our emotional and physical wellbeing, and tend to be aware of the risks we take in our lifestyle choices. ‘Quit smoking’, ‘take up more exercise’, ‘consider your dietary choices’ are all messages we are, quite rightly, regularly exposed to via healthcare professions, the government and social media. Dunbar argues that our social connections may

Friends: Understanding the Power of our Most Important Relationships Robin Dunbar Little Brown

have a profound impact on our health and wellbeing, perhaps more so than lifestyle risks like lack of exercise. It may be more important for us to consider the status of our social relationships and friendships for longevity, emotional wellbeing and physical health, rather than say, quitting smoking. Whilst he is in no way promoting smoking or other possibly harmful activities, the gravity of the statement really does hit home. Are friendships that essential to our lives? Dunbar argues that they are, and that more time should be spent considering our friendships in the context of health and wellbeing. Having devoured this book it now seems obvious that our social relationships do have such wide-ranging impacts, though it’s not often talked about. This book is a fascinating read. It considers concepts and ideas at the core of being human, and at the forefront of our minds as we navigate out of a year of physical distance from social relationships. When working with individuals experiencing mental health difﬁculties in the NHS, I will now hold in mind the importance of connection and friendship. Psychology often considers a systemic perspective in mental health, and this book reinforces how those social systems are critical to a sense of self, wellbeing and general health. Reviewed by Talia Drew, Trainee Clinical Psychologist

‘They had embodied a narrative’ Our editor Jon Sutton hears from Suzanne O’Sullivan about her new book, The Sleeping Beauties and Other Stories of Mystery Illness (Pan Macmillan). Dr Suzanne O’Sullivan has been a consultant in neurology since 2004, ﬁrst working at the Royal London Hospital and now as a consultant in clinical neurophysiology and neurology at the National Hospital for Neurology and Neurosurgery. She specialises in the investigation of complex epilepsy and also has an active interest in psychogenic disorders. Suzanne’s ﬁrst book, It’s All in Your Head, won both the Wellcome Book Prize and the Royal Society of Biology Book Prize. Her critically acclaimed Brainstorm was published in 2018. Her new book, The Sleeping Beauties and Other Stories of Mystery Illness, investigates some of the most remarkable diagnostic mysteries of the 21st century, as both doctors and scientists have struggled to explain them within the boundaries of medical science and – more crucially – to treat them. You write that up to a third of people attending any neurology clinic have a medical complaint that is likely to be psychosomatic in nature – real physical symptoms that

are disabling, but which are not due to disease and are understood to have a psychological or behavioural cause. And that can affect any symptom, disability, or organ of the body. Do you think understanding around that – in the medical community, and amongst the wider public – has changed in recent years? Psychosomatic conditions did not feature during my medical training. The subject rarely appeared in neurology journals or at medical conferences, which is shocking when you consider that a third of people who attend neurology clinics are likely to have a psychosomatic problem (functional neurological disorder). Most neurologists of my generation qualiﬁed with no strategy for addressing these problems. I am very happy to say that is changing. This has become an area of intense research interest and, with that, have come many new insights. I am hopeful for the future. Unfortunately though, we are not nearly there yet. Advancements have been slow to ﬁlter through

to the wider medical consciousness. My patients with dissociative (non-epileptic) seizures still tell me ugly stories about how they are treated by medical staff. You need only look at the lack of treatment facilities to know that psychosomatic disorders are not considered as important as other causes of disability. We would not consider making a person paralysed by a spinal cord injury wait two years for treatment but that is how long people with functional paralysis often have to wait. Of course, if the medical community is still catching up, the public are inevitably further behind. They still regard psychosomatic problems with disbelief, and more often judgment. The media often refers to the condition as a ‘mystery’ even where the diagnosis is known. There seems to be an ongoing struggle to accept that the body speaks for us. I am personally an open book of facial expressions and telling body language, but when I ask people to carry that concept through to the possibility of psychosomatic disability I see them struggle. There is a great deal of progress still to be made.

Language is central here, isn’t it? In Nicaragua there is a culture bound syndrome called Grisi Siknis (crazy sickness) which manifests as dissociative seizures and manic behaviour. Despite the pejorative sounding name, the condition has relatively little stigma attached to it. The seizures are not considered to be the fault of the person affected, so they attract compassion and community support rather than judgment. In meeting Nicaraguan people affected by this disorder I did not hear a single objection to the label. I think Western medicine could learn from this. The terminology used to refer to psychosomatic disorders is constantly changing. Increasingly bland labels are being used to create socially acceptability. I would suggest that demystifying the mind-body-environment interaction and making this an illness without blame would do more to remove stigma than yet another sanitising name change. In particular, I worry that cleansing psychosomatic disorders of words that refer to psychology (case in point, functional neurological disorders) actually adds to stigma by suggesting that disorders linked to the mind need to be hidden. More important than just words are stories. Several years ago a contagious sleeping sickness struck a small town in Kazakhstan. Those affected were certain they had been poisoned even though no poison was found. Medical tests strongly suggested a psychosomatic cause, a formulation that the town rejected. In 2019 I visited that community and they told me a vivid story about their unique lives that helped me see that the sleeping sickness was actually an incredibly sophisticated solution to a complex social problem. They had embodied a narrative. My patients do this too. The vivid mental picture of a slipped disc cutting through their spinal cord can be enough to create disability. I agree that reducing functional and psychosomatic disorders to ‘stress-induced’ ‘conversion disorders’ loses all the nuance in a patient’s internalised story and risks alienating them. But ongoing wordplay around the

disorder is not the answer. If a person feels understood and feels that they are believed, they care a lot less what labels you give them. What’s your experience of Psychologists in terms of understanding that ‘every medical problem is a combination of the biological, the psychological and the social’? Despite a great deal of talk about avoiding mind-body dualism I think it still exists in our practices. Medical problems are reduced to mostly biological or mostly psychological and that creates a treatment pathway that often only covers one aspect of the problem. In fact, I find psychologists to be more holistic than neurologists, who are inclined to either shy away from or ham-fistedly deal with conversations about mind-body interactions. Having said that I still encounter psychologists who struggle to accept the more extreme physical manifestations of psychosomatic disabilities and inadvertently communicate their disbelief to patients. Thus, treatment is doomed. More problematic is how we all deal with the social contributors to psychosomatic illness. It feels generally safer to conceptualise a person’s suffering through neurotransmitters, connectomes and cognitive mechanisms than to approach them as a social disorder. Doing so risks being seen to blame the patient for their own problem. What’s more many social problems are simply too big for any one professional to address. The media, educational systems, friends, family, spiritual beliefs are outside our domain. So, the majority of attention is given to internal processes, but, with that, I fear important conversations are being neglected. What are the implications of the artificial division into either biological, psychological, or social? I was struck by your point about that making it surprisingly easy for systems to leave people without treatment while they debate who is responsible for them. Our persistent division between mind, body and environment inevitably leads to reductionist treatment that focuses on one element of the problem. Many people with physical disability due to a functional neurological disorder are referred to a psychologist and discharged by their medical doctors. They are given psychological interventions but their physical disability is neglected. Or the converse occurs, in which a patient spends years undergoing medical testing without ever meeting a psychologist. In Sweden there is a condition called resignation syndrome that affects children of asylum-seeking families who are facing deportation. It manifests as a deep catatonic state that can last for years. It is a very good example of how a diagnosis of a biopsychosocial condition gives both the medical community and the general public permission to be neglectful. Because it is a social disorder these children are cared for at home and do not receive any active treatment. If every disease and every illness is part biological, psychological and social then joined up care should

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On biology, you say ‘ultimately that’s what everybody wants to know’, and that to truly consider brains ‘in the wild’ you needed a language you ‘haven’t yet learned to speak’. Over the years I’ve perhaps seen Psychologists veer away from reductionism and to speak the sociopolitical and cultural language… some would argue that’s now all they speak. Can your book help us strike a happy medium? I have the sense that many people can’t quite see how environment and the biology of behaviour connect. In writing this book I have tried to bring them together. People live in a rich social world, but we study them in sterile clinics. By leaving my clinic and talking to people in communities very different to my own I really came to appreciate how the richness of their stories shaped their expressions of distress. But in writing about what they told me I have also tried to frame their experiences in biological terms in order to give substance to the physiological reality of these conditions. It’s notable that so many of the people you meet in the book are young girls and women, and that you clearly feel they get a raw deal when it comes to how we think of psychosomatic illness. Have we really not moved on from the witch trials? In travelling to communities affected by mass psychogenic illness (MPI) I was very disappointed to see the difference between the way that young women were talked about, when compared to men. MPI in young women was attributed to petty love rivalries and sexual frustration. The women were portrayed as troubled and psychologically weak. Most of the outbreaks I encountered arose from a societal problem and had nothing to do with psychological fragility, and yet the women’s personal lives were picked over mercilessly. Men and older groups did not suffer that sort of disparaging scrutiny. Actually, more often than not, in them, the diagnosis was rejected – precisely because they were not young women. One group of teenage girls who developed a tic-like disorder were actually referred to as witches. I know of no other medical problem that is still associated with centuries old tropes. The more you get to the bottom of each mystery, the more I am reminded of the saying ‘More inhumanity has been done by man himself than any other of nature’s causes’. And along with a dash of humour, something that comes across to me in your writing is worry – for the futures of the people you meet, perhaps for the world in general. Do you think that’s fair, and if so did that increase through the researching of the book? I was certainly concerned by the absolute lack of willingness to accept the reality of psychosomatic conditions. The recent scientiﬁc progress has yet to touch most people. Every single group I met outright rejected a psychosomatic formulation to explain their disability. Each considered that diagnosis an insult. Even highly regarded

Jonathan Greet

always be available to address each element equally. I often think that my patients would beneﬁt more from a good social worker than a neurologist or psychologist, but few patients get quality input from all three.

US doctors still likened psychosomatic suffering to malingering. That was chilling to see. It trapped patients in endless cycles of fruitless medical testing that often made their symptoms worse. I also started to wonder if the western medical approach is the right one. Nobody I spoke to wanted to hear about processes like dissociation and predictive coding, they wanted their stories heard and validated. I was left wondering if the entire way that I conceptualise these problems was actually doing people a disservice. What implications does all this have for treating illness? Of all the MPI groups I met there was one consistency – they outright rejected that diagnosis and the western medical approach failed to help them. In fact, a diagnosis of MPI or any psychological formulation was certain to make them worse. What helped were ritualised, spiritual and symbolic treatments. Recovery depended on the group’s ability to ﬁgure out what social problem their symptoms had come to solve and then solving it. In the face of a psychosomatic diagnosis people reinforced their symptoms to prove their suffering. As a neurologist I have a tendency to meet these disorders head on in my own patients. I explain how the cognitive processes that make up the mind interact with other biological brain processes to create physical disability. I realise now that approach is only suitable for people like me who ﬁnd relief in a psychosocial explanation. I need to learn to recognise those for whom that is not the best approach and listen to and work with the formulation they are using to explain their symptoms. Sathnam Sanghera called you ‘the best science writer around – a true descendant of Oliver Sacks’. How does that feel? I make a concerted effort to never read anything anybody says about me, good or bad – but I couldn’t avoid Sathnam’s far too generous words because my publisher put them on the front of my book! I am endlessly grateful to him for his kindness, but I’d be a fool to believe it. Do you have a tip for our readers looking to write about psychology for a wider audience? It’s very hard to strike the right balance between telling the absolute truth, protecting patients and acknowledging differing opinions. I write with the idea that actual patients are in the room with me, and I don’t write anything that I wouldn’t say directly to them.

Suzanne O’Sullivan

‘Why aren’t there more of us?’ Nina Higson-Sweeney, a psychology PhD student of mixed heritage, discusses her podcast series Black Future Dr with Associate Editor Chrissie Fitch Tell us about your professional and personal background, and what you currently do. I’m a first-year PhD student at the University of Bath, exploring the issue of fatigue in teenagers with depression. Prior to my PhD, I completed a degree in Psychology and then a MSc in Health Psychology at the University of the West of England. I was born in London but grew up in Plymouth, and I am Mixed White and Black Caribbean, with grandparents from Montserrat. I was raised by the white side of my family in a city that lacks diversity, so I only recently started to explore and embrace the black side of my identity. One way I’ve been doing this has been through the podcast. What made you start this podcast? Do you ever have those moments where an idea comes to you out of the blue and you think ‘oh wait – this is actually doable’? I had that moment in October last year. I had been doing my PhD for a month, and being the only black student in my cohort was weighing on my mind. I kept thinking, where are we? Why aren’t there more of us here? And what can I do to change this? The idea of the podcast slowly started to form. I tweeted to see if there was any interest and had an amazing response from people worldwide – not only was there a gap for this, but the information was really wanted. So I started this podcast for several reasons. One was for promoting visibility, as it can be difficult to imagine yourself in a job if you have never seen someone who looks like you in that role: a particular issue in academia. To this day, I have not had a one-on-one conversation with a black doctor or professor. Education was another reason – I’m a firm believer that a great way to gain new knowledge is to hear from people with lived experience. A final reason is one of celebration – I wanted to showcase the incredible work being done by black doctoral students across the UK and demonstrate the wider impact we are having on our fields early in our careers.

Nina Higson-Sweeney

Why did you call your podcast Black Future Dr?

The initial name I had was ‘Future (Black) Dr’. I felt this represented who we are – students working towards the title of Dr – who are black, which inﬂuences our experiences and journeys. However, after speaking with some members of the African-Caribbean Research Collective, we felt that having ‘black’ in brackets could be interpreted as diminishing that part of our identity - the exact opposite of the podcast’s aims. Hence ‘Black Future Dr’. As a person of colour who has applied for PhDs, I found the episodes particularly relatable. What impacts do you feel the podcast has had? That’s so encouraging to hear! Quite a lot of the feedback I’ve received has been about relatability – we have such a diverse range of guest speakers and topics that there is (hopefully!) something for everyone. I think that the main impact of the podcast has been helping others to feel seen and to know they’re not alone. Doctorates are tough and are isolating at the best of times – it’s even harder during a global pandemic when so many people are working from home. I know personally that I have second-guessed my progress in doing my PhD, so being able to listen to others share similar experiences has been really validating and motivating. I also think that the podcast has helped to demystify the doctoral process. Unless you’re in a space with

the psychologist september 2021 culture

people who have that knowledge, it can be difficult to understand how you even begin to look for doctoral programmes, let alone choose supervisors, apply to the programme, apply for studentships, design studies – the list goes on! I think the podcast has helped to provide some of that information, or at least signpost people to helpful resources. I hope it has made doctoral programmes a bit more accessible to the black community. All 12 episodes of the first series have now aired. What do you feel you have achieved? I feel I have achieved what I set out to do – that is, to create a resource for black students that was educational, accessible, and freely available over time. I’ve also connected with so many wonderful black doctoral students across the UK to share their stories, so I think I have helped increase our visibility, if only a little bit. Do you have a favourite episode? I’m not sure! Each episode could be my favourite, because they have all taught me something new. For example, Episode Five with Emmanuel prompted a lot of self-reflection about my identity as black. But I suppose I picked Lateesha’s episode to be the first one for a reason – not only has Lateesha been an informal mentor to me since I began my PhD, but she is a fantastic speaker and her episode is particularly encouraging for prospective PhD candidates. Lateesha spoke candidly about her PhD journey, acknowledging the challenges but also emphasising the positives. Her episode might be a personal favourite because it reminds me why I want to be here and that my PhD is doable. Where do you hope to take the podcast in future? I currently don’t have future plans – I’ve been focused on making this series a reality. It would be great to create a second series of Black Future Dr, and to make scripts of the current series available, but I would definitely need more help with both. I would love to see others pick up where Black Future Dr has left off, and create more podcasts, videos and resources to continue promoting the visibility of black doctoral students, and to encourage other black students to join us. We will never have enough of these resources, and I think it can make the most impact when it comes from the community itself. The podcast series, Black Future Dr, is available on Acast, Spotify, Apple Music, Google Podcasts and Deezer. Tweet at @BlackFutureDr. You can contact Nina by email at nhs35@bath.ac.uk or by Twitter at @n_higsonsweeney.

Eerie and captivating unstable scientist’s revelations. Have you ever stared into the mirror Hearing this story whilst staring at and scrutinised the face that gazes my reflection, I got the sense that my back? How do you know it really is eyesight was playing tricks on me. you? It looks exactly like you but how Did my face didn’t look this haggard would you know for sure? at the start? Is my face becoming If this level of existential less visible the longer this goes on…? questioning leaves you clammy, Then, after a shocking climax, short of breath and filled with dread, it turns out he’s not Paul at all, then perhaps this isn’t for you. he’s Simon Watt, the creator of this But, for those of you who stride out show and he’s joined into uncertainty with by physicist Jennifer curiosity, then this part Smillie and psychologist immersive play, part Online performance Kate Storrs to explain education on physics The Mirror Trap what the hell just and psychology might Edinburgh Science happened. be your cup of tea. Festival This dynamic of a It all began quite post-show discussion mysteriously. An email with experts in the areas covered was from scientist Paul Gotes invited me particularly insightful. Sometimes a via Zoom link to attend his research science heavy play, film or book can webinar. A list of requirements for go straight over your head if you can’t the ‘research’ followed – a mirror, engage in the basic principles it deals headphones, a whiteboard marker with. However, get a team of experts and a dimly lit room. All this, along to wander out (virtually) and give you with the line ‘Please keep this a detailed explanation of quantum between the two of us’, suggested physics or the top down neural this wasn’t going to be your typical mechanisms responsible for visual online lecture. illusions and you’re sorted. A bit like Paul’s shaky voice broke through if Brian Cox popped up at the end my headphones and it was clear he credits of Interstellar and outlined wasn’t doing great. I was instructed how you get McConaughey on the to stare into my own reflection, interdimensional side of a bookcase. fixing my eyes, whilst Paul began his This show was an enjoyably explanation of the research we had unnerving and educational 50 unwittingly become a part of. minutes and I will never look at my What ensued was an eerie face in a mirror the same! and captivating monologue, using theories surrounding quantum Reviewed by Harry Clark, mental physics and multidimensional health researcher realities to draw you into this

‘Anything but the eyes’ Why do so many people refuse to donate their corneas when they die? An exhibition of artworks by psychologist Dr Jennie Jewitt-Harris explores the question. Most people are supportive of organ donation, yet a signiﬁcant proportion of potential donors refuse corneal donation despite being willing to leave all other organs. One in eight registered donors restrict their organs for donation with 89 per cent of these excluding corneas. A new exhibition of art from psychologist Dr Jennie Jewitt-Harris explores why. ‘The concern regarding corneal donation for some people is so great that the social and moral pressure to donate cannot overcome it,’ Dr Jewitt-Harris told us. ‘Assumptions are often made about the reasons why, and are wrongly attributed to religious beliefs or squeamishness. The reasons are actually poorly understood. Surveys of potential donors have revealed a signiﬁcant number of people unable to describe why they say no.’ Dr Jewitt-Harris has used an art/psychology research approach to investigate the concerns

‘I had the dream of what I wanted and gave myself permission to do it’ Experienced Clinical Psychologist and Founder of Good Thinking Psychological Services, Dr Marianne Trent (pictured), discusses her work with Associate Editor for Culture, Chrissie Fitch. https://tinyurl.com/psychmagtrent Also online… Gaslit: shining a light on narcissistic abuse We hear from Artist Veronica Rowlands and Clinical Psychologist Dr Thomas Italiano about a new art participation project and exhibition. See thepsychologist.bps.org.uk/gaslit-shining-lightnarcissistic-abuse 72

underpinning the decision. A semistructured interview technique was used to elicit beliefs and metaphors that underpin concerns for participants who refuse to donate their corneas but are willing to donate all other organs. ‘A qualitative grounded-theory approach has value here for its expansive role in understanding areas like this that cannot be accessed quantitatively, opening new avenues of psychological enquiry, interpreting such phenomena in terms of the meanings that people bring to them. Discourse analysis tools were used to reveal common themes that were explored using creative artistic practice. Art was used as a medium to connect with and embody the feelings of participants as an alternative language to communicate and express concerns. Follow-up interviews were held to discuss the emerging artworks and develop them further to connect with concerns.’ The themes revealed through the artworks were: the physicality of the eyes could not be separated from self and identity; the eyes were perceived as a personal black-box recorder of life that must not be shared; donating the eyes was equated with the erasure of identity; and the eyes are equivalent to the self and a deep inter-connection exists between anatomy and the individual lived experience, with the eyes carrying the past of their owner into death. ‘ The artworks created an important catalyst for discussion, Jewitt-Harris said, encouraging people to consider/discuss their desire to donate corneas, and to

understand the views of those who decline. ‘Non-gift-of-life views and refusal to donate is often challenged as superstitious, selﬁsh, and ignorant. The research participants, however, expressed feelings of embarrassment and guilt, with fear of being seen as illogical, selﬁsh, and squeamish. The debate about donation must acknowledge that non-religious deeply-held spiritual beliefs need to be respected. The desire to push through this is understandable, but space must be created for alternative beliefs and wishes to be upheld, understood, and respected. The option to opt-out of donation of certain organs rather than all organs may be needed for some to protect their eyes.’ The exhibition Anything But the Eyes is at South Hill Park Mirror Gallery, Bracknell, 8 July – 2 October 2021. www.jenniejh.co.uk

the psychologist september 2021 culture

Alcohol’s complex cultural images Alcohol is ubiquitous in cinemas generally (think ‘shaken of seductive, distracting language designed to tempt not stirred’ as a starting point) and sometimes an customers to try an establishment’s sparkling wines and indirect focus of films – e.g. The Hangover films, suicidal ‘velvety vodkas’. alcoholism dealt with in Leaving Las Vegas and Alexander The film’s somewhat mixed message about alcohol Payne’s acclaimed road trip Sideways. Alcohol reflecting might be no bad thing in itself, and I think this was partly life’s tragedies, and alcohol reflecting the clear comedies the director’s intention. Another Round casts alcohol of life: just what is the breadth of framing for alcohol to as a source of friendship and vitality for Martin and his have within cinema? Enter Another Round (the Danish title, friends, each of whom is facing demanding moments in Druk, meaning ‘binge drinking’, is far superior), a comedylife. However, alcohol is also presented as something that drama directed by Thomas Vinterberg whose The Hunt destroys family relationships, something that leads to (2012) impressed with its considered depiction of family injury and argument, and that carries stigma in certain and moral hysteria. contexts (e.g. when linked to the workplace). And The film hinges around four this mirrors alcohol’s complex cultural images: as film middle aged male university something flippant and light-hearted; as a destructive, Another round teaching colleagues who decide addictive behaviour; and as something which, partly Dir: Thomas Vinterburg by virtue of its diverse psychopharmacological to put into practice the hypothesis of Norwegian psychiatrist Finn mechanisms of action, has unpredictable and Skårderud, who has argued that inconsistent effects. The film succeeded most when having a blood alcohol content (BAC) of 0.05 per cent is it captured the swings between alcohol’s dizzy highs conducive to feeling more relaxed and creative. While we and its desolate lows. But these contradictory visions might clearly argue about details and qualifiers for such of alcohol’s effects in everyday life felt, at times, like too a theory, a perspective arguing for possible evolutionary much dalliance, particularly in the closing alcohol-fuelled advantages of not irregular alcohol intoxication feels celebratory scene which clashed against more serious refreshing (hits the parts other theories do not). But the images conveyed in earlier film parts. theory serves as the film’s central spine: seeing whether My lasting thought on this film was: what should a having a tipple at work helps these jaded teachers teach film with alcohol towards its centre of gravity look like? and whether an intoxicated teacher inspires learning Where might the moral boundaries be best placed in such among the students. Clearly such a plan comes with a film? Are artists bound to present alcohol’s addictive clear risks to working life and these unfold over the properties? How well placed is cinema to articulate course of the film, as does a changing relationship with tensions and possibly hypocrisies involved in thinking the teachers’ personal and collective relationship with about, researching and creatively documenting alcohol’s alcohol. place in human life? There are no easy answers to these The psychology of alcohol consumption is dealt with questions but Another Round feels a step closer towards in an intelligent, thoughtful way in many scenes. As producing a more satisfactory route forward. someone who has explored how social sobriety/alcohol abstinence is experienced and dealt with rhetorically, I Reviewed by Dominic Conroy, PhD, SFHEA, Senior particularly enjoyed an early scene where Martin attends lecturer, School of Social Sciences - Psychology, London a social event as a non-drinker and endures an onslaught Metropolitan University

Forbidden histories Callum E. Cooper interviews Andreas Sommer on the importance of historical awareness for psychology Could you tell readers about your background, and how your research is relevant to psychology? I’m a historian of science and medicine studying hidden links between the sciences and the ‘occult’ from the Scientiﬁc Revolution to the 20th century. A major part of my research has been the relationship between psychical research and modern experimental psychology, which emerged together in the late 1800s. I’m mostly interested in important historical developments that didn’t make the ‘cut’ in ofﬁcial histories of modern psychology. For example, it’s well known that some of the ‘founders’ of the discipline, such as Gustav T. Fechner and William James, were very interested in alleged psychic phenomena. However, the extent to which they investigated them and collaborated with other researchers is rarely acknowledged. In the case of James, for example, it’s not widely known that his most important collaborator in psychological matters was Frederic W.H. Myers, the British inventor of the word ‘telepathy’.

Callum E. Cooper, PhD, is a senior lecturer in psychology at the University of Northampton and a Chartered Member of the BPS. 76

Did you look at Wilhelm Wundt in Germany, who is also often credited as a ‘founder’ of modern psychology? Yes, quite extensively. As you know, Wundt was a vocal critic of investigations of spiritualism and other ‘occult’ phenomena such as telepathy. Attacks by Wundt and other early psychologists have often been portrayed as self-evident instances of ‘science’ vanquishing ‘superstition’. But once you engage with the primary sources, the historical facts quickly undermine such interpretations. For example, Wundt and others (such as G. Stanley Hall in the US) never expressed their misgivings of James and fellow psychical researchers in terms of dispassionate, methodological criticisms. In fact, they often strongly misrepresented their actual positions and methods of investigation. What’s more, psychological critics like Wundt and Hall made no secret of the strong religious motivations for their hostility to psychical research. It’s often forgotten, for example, that Hall’s original career was that of a minister and preacher. Warnings of supposed dangers of the occult for ‘true religion’ are a recurring topic in the supposedly ‘scientiﬁc’ critiques of Hall, Wundt and other psychologists. I tried to sketch these broader international contexts, for example, in my PhD thesis and a recent

Andreas Sommer, PhD, is a historian of science and medicine with a background in philosophy and psychology. After holding various research posts at the University of Cambridge, he is now an independent scholar.

chapter in the Oxford Handbook of William James. I’ve introduced my students to your YouTube channel ‘Forbidden Histories’. What do you mean by ‘forbidden’? ‘Forbidden’ may sound a little melodramatic, but it captures what I think is a genuine taboo. There’s a somewhat stubborn refusal of academic orthodoxy and certain science popularisers to face certain ﬁndings of perfectly mainstream history of science, because they don’t sit well with the ‘naturalistic’ self-image of western science and academia. Isaac Newton’s systematic studies of alchemy and apocalyptic prophecies may now be more or less considered part of common knowledge. But tell the average scientist that, for example, Copernicus, Kepler and Galileo were all practising astrologers (who cast horoscopes not just for money, as some have claimed, but because they believed in it), and you can be sure of interesting responses. Moreover, Newton has been called ‘the last magician’, but this label is misleading because we can see a clear continuity of scientists being quite open-minded about ‘magic’. Physics and Psychics by Richard Noakes (Cambridge University Press, 2019), for example, has interesting insights about occult preoccupations of British elite physicists beyond

the psychologist september 2021 looking back

the ‘usual suspects’ William Crookes and Oliver Lodge, including Nobel Laureates J.J. Thomson (the discoverer of the electron) and Lord Rayleigh. Speaking of big names in physics, it’s also not widely known that both Marie and Pierre Curie took a serious interest in the alleged physical phenomena of spiritualism. Pierre in particular was convinced that they were dealing with real and fundamental anomalies. At the same time, the Curies and most other investigators of mediums on the continent were not at all interested in proving the reality of spirits, and they in fact often rejected spiritual or religious interpretations of the ostensible phenomena. The history of science and the modern occult especially in continental Europe has many other examples in store. Are you saying history clearly demonstrates anomalous cognition as a fact? I don’t think historians should be expected to do the job of scientists, who ought to feel responsible to answer such questions (instead of delegating this responsibility to militantly sceptical stage magicians and other professional debunkers). And as a historian I’m actually not very interested in validating or debunking occult phenomena. I also don’t like arguments from authority, along the lines of ‘many icons of modern science believed in the paranormal, so you should too’ (or similar arguments from the sceptical end of the spectrum). What I want is to obtain a qualified understanding of why scientists have believed as well as disbelieved in the paranormal. This requires looking at the actual methods they employed to investigate the claimed phenomena, and doing justice to the wide range of interpretations. For example? Take another icon of modern science, the co-founder of modern evolution Alfred Russel Wallace. He was a devout spiritualist, but looking at his almost absolutely uncritical engagement with mediums, it’s clear his scientific eminence alone shouldn’t be taken as a voucher for the truth of his spiritualist convictions. At the same time, contemporary criticisms of Wallace’s spiritualism, e.g. by the physiologist Edward B. Carpenter, were not particularly ‘scientific’ either. Doing history properly also involves an understanding of the actual means by which western academics have come to be accustomed of pigeonholing any belief in parapsychological phenomena as inherently unscientific. It turns out science had precious little to do with it, which is another somewhat shocking but robust consensus reached by mainstream historians who have investigated this question. (For the British context, see the recent book The Decline of Magic by Michael Hunter, a leading historian of Enlightenment science). In this regard, it’s also indispensable to understand crucial political dimensions which have lastingly shaped western perceptions of the phenomena – for

example, the role of anti-Catholicism and secular politics during the professionalisation of psychology and other university disciplines in the 19th and early 20th centuries. It would be absurd, for example, for a future historian to write a history of, say, early 21st century American climate science failing to mention the active lobbying of climate change denial by the Republican party. But as far as they are interested in history at all, psychologists typically rely on historical narratives of science-magic relationships which are on this level, and which tell only those parts of the story which

ﬁt traditional simplistic ‘science vs. superstition’ narratives. Why do you think is this important to present-day psychologists? Evidence matters not only in science, and history can’t be just a free-for-all. Scientists should have an intrinsic interest in getting at least their basic historical facts straight. Looking at the past and presence of psychology, you get a strong sense that popularisers of the discipline have often tried promoting the public and scientiﬁc image of their discipline by intentionally disavowing any positive links to the occult. Like every science, psychology needs its popularisers, but even popular writings can and should be fact-based. There’s also been a strong tendency by ‘sceptical’ psychologists to explain belief in the paranormal in terms of biases and wishful thinking. The other side of the coin – e.g. primordial fears of the unknown and other reasons that may bias us toward categorical disbelief – is never really addressed. I think such a

Find our Looking Back articles at https://thepsychologist.bps.org.uk/lookback

To contribute a piece on the history of psychology or the psychology of history, contact the editor on jon.sutton@bps.org.uk 78

one-sided focus is hair-raisingly simplistic, especially when adopted by psychologists. Being aware of the passionate hostility which has characterised many supposedly ‘scientific’ responses to psychical research, I think work in the ‘psychology of paranormal belief’ requires a more rigorously symmetrical perspective. Finally, I think there’s also a need to face certain rather unsavoury aspects of battles against the ‘occult’ by past psychologists like Wundt, Hall, Joseph Jastrow and others. These and other psychologists were vocal in their views that any tendency toward occult belief was a clear-cut indication of mental degeneration. Viewed as morbid throwbacks into past stages of mental evolution, belief in the paranormal was held to be characteristic of the ‘lower races’, and therefore considered as evidence of degeneration when appearing in the ‘superior’ ones. Do you think there may be other clinical lessons to learn from history? Yes, and as the humanities are increasingly being starved out of the universities, I think if they want to survive, historians actually need to stress the ‘cash value’ of their research for improving the human condition. I think it goes without saying that belief in the paranormal is not good or healthy for everyone. Still, since about the 1970s there’s also been a growing body of research suggesting that for many people certain exceptional experiences can be an important coping resource. Think, for example, of the literature on ‘hallucinations of widowhood’ or clinical trials showing the success of therapeutic treatments based on the psychedelic induction of ‘mystical’ experiences. However, the insight that unusual experiences can have therapeutic value is hardly new. At a time when other psychologists and medics often pathologised occult and mystical experiences wholesale, William James stressed the constructive clinical and social functions of some of them… despite the fact that James was not very religious himself and far from convinced of, say, life after death. Yet, James’s appeals to the scientific and medical communities of his day fell largely on deaf ears, and it took almost a century until western clinicians began developing more nuanced and patient-centred approaches to exceptional experiences and mental health. The damage through misdiagnosis and overmedication of patients reporting certain extraordinary but not necessarily pathological experiences may be hard to assess quantitively, but it has been real. It is also a reminder that medical training is often grounded in absolute cultural presuppositions, including the assumption that scientific, medical and psychological knowledge steadily grows in a more or less linear fashion, and that science is inherently selfcorrecting. Mainstream studies in the history of science and medicine show that this is not necessarily the case, especially concerning empirical approaches towards some of the most fundamental human questions.

The only series to be approved by the BRITISH PSYCHOLOGICAL SOCIETY

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This month we meet… Katherine Carpenter Clinical Neuropsychologist and new President of the British Psychological Society

One shared value for members Making a difference. It underpins so much of what we strive to do for impact, by promoting the highest standards of scientific research, of clinical and organisational working, of political influence and of societal change. One thing from the Society’s new six-point strategic plan that stands out for me Promotion and advocacy of diversity and inclusion within the discipline and practice of Psychology. It would be fantastic if we could alter the perception some people have that the BPS is an old fashioned, white, middle-class organisation with little relevance for them. One thing psychologists should be proud of How we’ve responded to Covid-19 – researching the virus and the brain, diverting from the day job into PPE on ITU to help patients connect by iPad with their families, advising the Government, surviving home schooling/lockdown/remote working as well as personal losses. And we’ve collectively put out some helpful guidance in a swift and timely fashion. But there is more still to do, particularly around long Covid. One book which has influenced me The somewhat quirky and dated When the Air Hits Your Brain: Tales from Neurosurgery by Frank Vertosick. Many of my specialist interests involved working with neurosurgeons in epilepsy surgery, subarachnoid haemorrhage and neuro-oncology.

One proud moment When I learnt to do headstands and handstands recently! We emphasise parity of esteem in relation to mental and physical health, but I think as psychologists we need

one on one

to learn to look after our physical well being as well as our emotional health. Balance, stamina and strength are important as we age, and learning to trust your body is exhilarating! One film Doctor Zhivago, directed by David Lean in 1965, though it’s old now and probably looks pretty dated. My maternal grandparents left St. Petersburg in 1917 leaving their first child behind, and walked into Finland to escape the revolution, coming to the UK from Poland when my mother was seven. There are family photos of them in troikas, and my mother used to tell me about her father clapping his hands to frighten away the packs of wolves in the forest, as Zhivago does at their Varykino dacha in the film. One nugget of advice for aspiring psychologists Career progression is often not linear. Explore what interests you. Follow your instincts. One person who has inspired me Professor Chris Frith, at UCL. Chris supervised my clinical psychology research dissertation on motor skills in Parkinson’s disease. I remember his wise advice to me that it is ok not to know, and the one time it is absolutely fine not to know stuff, is when you are a student or trainee. I always felt my questions might be stupid, or if I was cleverer or worked harder, I would somehow know or remember the answer. I got to notice later that is often only the most senior colleague in the seminar who dares to say, ‘Can you run X past me again? I’ve never been clear how X works’. Something I remind my students. One thing that keeps me awake at night Climate change. I read that neanderthal man and dinosaurs were both wiped out by pandemics and climate change. Salutary. Twelve months as President is no time at all, but anything I can do to promote members’ work in the area so we influence Government policy I will try and do. More at thepsychologist.bps.org.uk

coming soon… evolution and prosociality; lived experience amongst psychologists contribute… reach 50,000 colleagues, with something to suit all. See www.thepsychologist.org.uk/ contribute or talk to the editor, Dr Jon Sutton, jon.sutton@bps.org.uk, +44 116 252 9573 comment… email the editor, the Leicester ofﬁce, or tweet @psychmag to advertise… reach a large and professional audience at bargain rates: see details on inside front cover maybe you missed… …September 2018, ‘Yawning at the apocalypse’: Cameron Brick and Sander van der Linden on responses to climate change. …Search it and so much more via www.bps.org.uk/thepsychologist

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President Katherine Carpenter President Elect Dr Nicky Hayes Honorary General Secretary Christina Buxton Honorary Treasurer Dr Roxane Gervais Chair, Education and Training Board Professor Niamh Stack Chair, Practice Board Alison Clarke Chair, Member Board Professor Carol McGuinness Chair, Research Board Professor Andrew Tolmie Trustees Dr Peter Branney, Dr Esther CohenTovee, Dr Adam Jowett

Chief Executive Sarb Bajwa Change Programme Director and Deputy CEO Diane Ashby

society notices

society vacancies

BPS conferences and events See p.7

Using the Consultant Title – Task and Finish Group See p.20 Education and Training Board – Members See p.27 2023 European Congress of Psychology – Scientiﬁc Committee call for members See p.32

Director of Communications and Engagement Rachel Dufton Director of Finance and Resources Phil Hodgett Director of IT Mike Laffan Director of Knowledge and Insight Dr Debra Malpass Director of Membership, Professional Development and Standards Karen Beamish Head of Legal and Governance Christine Attﬁeld

The Society has ofﬁces in Belfast, Cardiff, Glasgow and London, as well as the main ofﬁce in Leicester (St Andrews House, 48 Princess Road East, Leicester, LE1 7DR).