The Psychologist May 2019 by The Psychologist

the

the psychologist

psychologist may 2019

may 2019

How do we ‘other’? Peter Hegarty considers how ‘habits of thought’ affect social fairness

also… Embedding psychology in public policy

www.thepsychologist.org.uk

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the

the psychologist

psychologist may 2019

may 2019

contact The British Psychological Society 48 Princess Road East Leicester LE1 7DR 0116 254 9568 mail@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 Kai Theriault 01223 378051 kai.theriault@cpl.co.uk april 2019 issue 45,521 dispatched cover Nick Oliver www.nickoliverillustration.com environment Printed by Warners Midlands plc on 100 per cent recycled paper. Please re-use and recycle. Mailing bag is potato starch-based and fully compostable. 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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How do we ‘other’? Peter Hegarty considers how ‘habits of thought’ affect social fairness

also… Embedding psychology in public policy

www.thepsychologist.org.uk

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, tweet us on @psychmag or call /write to us at the Society’s Leicester office.

Managing Editor Jon Sutton Deputy Editor Annie Brookman-Byrne Production Mike Thompson Journalist Ella Rhodes Editorial Assistant Debbie Gordon Research Digest Christian Jarrett (editor), Emma Young, Matthew Warren

Associate Editors Articles Paul Curran, Harriet Gross, Rebecca Knibb, Adrian Needs, Paul Redford, Sophie Scott, Mark Wetherell, Jill Wilkinson History of Psychology Alison Torn Interviews Gail Kinman Culture Kate Johnstone, Sally Marlow Books Emily Hutchinson Voices in Psychology Madeleine Pownall International panel Vaughan Bell, Uta Frith, Alex Haslam, Elizabeth Loftus, Asifa Majid Psychologist and Digest Editorial Advisory Committee Catherine Loveday (Chair), Emma Beard, Harriet Gross, Kimberley Hill, Rowena Hill, Deborah Husbands, Peter Olusoga, Richard Stephens, Miles Thomas

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the

psychologist may 2019

Letters Leaders, the digital NHS, benefits and more How can we embed psychology in policy? We ask the Society’s Policy Team News Society awards, report from the ICPS, and more

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Digest The placebo effect, and more of the latest research

Dads get sad too Viren Swami withdrew from his newborn son…

A message of hope and resilience Clare Jones and Alan Barrett on the development of a Hub in response to the Manchester Arena attack

‘We should just be told to try our best’ Laura Nicholson and Dave Putwain on exam anxiety

‘An ecological approach to resilience is essential’ Louise Roper hears from Kate Bennett

How do we ‘other’? Peter Hegarty on asymmetries of reasoning

‘We are not at a place of full acceptance or equality for trans people yet’ We hear from Robin Dundas

‘We need to change the conversation’ Forensic psychologist Terri van Leeson

Jobs in psychology

Books Reviews, plus we hear from novelist Ewan Morrison

Culture Dame Kelly Holmes

Looking back David Lewis-Hodgson on the ‘will of war’

One on one

On 1 and 2 May in Harrogate, the British Psychological Society will be holding its Annual Conference. The event features an increased focus on public policy, impact, and collaborative working, with an overarching theme of ‘the psychological impact of inequality’. This reflects the Society’s changing priorities. The staff Policy Team is growing, and we meet many of them on p.8 as they address how we can embed psychology in public policy (also the topic of The Psychologist’s own ‘fringe event’ at the Conference). Fundamentally, equality comes down to how we group people and then how we treat them on the basis of that group membership. That feels like a thread throughout this issue, connecting our lead letter on the Christchurch massacre, Peter Hegarty’s cover piece on how we ‘other’ (p.48), and several other interviews and features. As ever, it’s a packed issue and the months fly by… do get in touch if you think you could contribute! Dr Jon Sutton Managing Editor @psychmag

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‘We can be the nation that discovers the cure’ Getty Images

Prime Minister Jacinda Ardern arrives to attend islamic prayers in a park near Al Noor mosque

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The Christchurch massacre once more raises a question that has been at the core of developments in social psychology since the end of the Second World War. How can we understand the roots of hatred and of violence against members of other groups, and how can we contribute to their eradication? But the relationship between our discipline and the tragic realities of intergroup antagonism is not one way. We are not just in a position to teach but also to be taught. And if Christchurch shows us anything, it is the critical importance of leadership. Far too often, we treat prejudice and racism as if they derive from the psyche of the individual either as specific quirks of personality or as generalised biases of the cognitive system. To do so is to ignore the importance and accountability of those who articulate a hateful cause and thereby make it possible for some (like the Christchurch killer) to take it upon themselves to act as foot soldiers, or martyrs, in that cause. In our piece for The Psychologist website, we analyse the steps involved in creating such a cause. We show how the starting point lies in narrowing the definition of the community so as to exclude particular minorities such as Muslims (‘they are aliens with alien values’). We show how the shift from exclusion to violence lies in constituting the ingroup as noble and the minority as an existential threat to the ingroup. And we show that when all this is in place, then brutality to the minority can be elevated as the defence of virtue. In this way we provide a nuanced approach which shows how casual Islamphobia is implicated in the process leading to Christchurch without being identical to the ideology of the killer. But, if toxic leadership which excludes and demonises is a central element of intergroup hatred, so leadership is also central to overcoming hatred and achieving

reconciliation. If anything, it is an appreciation of the constructive potential of leadership which is most critical to us as psychologists. A few years back the Equalities and Human Rights Commission (EHRC) commissioned a report on what we have to offer to improve intergroup relations and the answer was ‘precious little’. The tools we do have, such as ‘unconscious bias’ training, are under increasing scrutiny. So we are in real danger of seeming irrelevant in an area that is one of our greatest concerns. A group level analysis of the ways we construe our communities, and the role of leadership in this, provides an important way forward. Moreover, the responses of New Zealand Prime Minister Jacinda Ardern teaches us much about what constructive leadership looks like. At the core of everything she has done is the realisation that condemning the massacre, however strongly, is not enough. The key element is how one talks about the victims and more particularly, whether they are positioned as inside or outside the community. As Ardern put it, when she visited Christchurch the day after the massacre – not only in words but also in gestures and policies – ‘they are us’. The same sure touch was evident in Ardern’s speech at the memorial service to the victims two weeks later. For there was a danger in Ardern’s insistence that New Zealand abhors racism and is defined through antiracism. It could be used as a denial of past and present injustices, a call to complacency. But Ardern expressed it as an ideal and an aspiration, a call to action so ‘we’ (New Zealand) can be who we really want to be. Thus, to use her own words, Ardern spoke of: ‘a responsibility to be the place that we wish to be. A place that is diverse, that is welcoming, that is kind and compassionate. Those values represent the very best of us’. She continued: ‘we

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the psychologist may 2019 letters

Technological advances in mental healthcare

are not immune to the viruses of hate, of fear, of other. We never have been. But we can be the nation that discovers the cure’. Equally, by rooting our analyses of racism in real world events, by testing our theories against those events and learning from their deficiencies, then our discipline will be better able to become part of the cure. This will not be an easy process. Indeed at times it will be distressing and even traumatic. For, as in this instance, it means engaging with the hateful ideas of the killer and his milieu. It means taking their perspective, seeking to understand how they made sense of the world, and hence how wholesale slaughter could become thinkable for them. There is a cost here, a cost which makes it all the more essential that our work makes a difference – for only that renders such work justifiable. More concretely, then, we argue that a full understanding of Christchurch, and of how to stop future Christchurches, depends upon reinstating leadership at the core of the analysis, and immersing ourselves in the study of both toxic and inclusive leaders. Steve Reicher University of St Andrews Alex Haslam University of Queensland Jay Van Bavel New York University Editor’s note: ‘The road to Christchurch: A tale of two leaderships’ was described by @sarb on Twitter as ‘One of the best articles I’ve ever seen @psychmag produce and I’ve been a member of the BPS since 1988’… seek it out at https://thepsychologist.bps.org. uk/road-christchurch-tale-two-leaderships Getty Images

In an exclusive piece on our website, Laura Bolger – a Trainee Forensic Psychologist and ex-police officer – gives us her perspective on the newly adopted ‘public health approach to gangs’. She explores gangs as structured, hierarchical groups involving role-transitions. Is an identity framework the key to addressing knife crime? https://thepsychologist.bps.org.uk/ gangs-what-can-psychology-offer

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What happens in the NHS in the UK matters to nearly all of us. Our health, and that of our families and friends, is in its hands. Then there’s our working life: many psychologists have professional and academic healthcare roles. The NHS is greatly valued but is under strain and operating in changing times: so how can it make the most of innovative technologies such as genomics, digital medicine, artificial intelligence, robotics and the like to improve services? The NHS (via Health Education England), aware of the potential benefits and challenges of new technologies and their demands on healthcare practitioners, commissioned a review led by US cardiologist, geneticist and digital medicine researcher Dr Eric Topol. Literature reviews, expert opinion and focus groups informed the review. Major digital technology trends were considered, with their implications for services and staff training. February 2019 saw the publication of the Topol Review, and a supplementary report exploring the digital future of Mental Healthcare (topol.hee.nhs.uk). The reports set key considerations for the healthcare ecology, emphasising that the patient must be at the centre when new technologies are being introduced; that applications are clinically validated; that patients should ‘opt in’ to their use; that efficiencies from technology use should enable more time for the clinical relationship; that the workforce will require a wider cross-disciplinary mix, for instance, including computer scientists; and that workforce education must prepare all staff for technological developments. The reports further emphasise that with the introduction of new technologies, ethical and other implications need to be considered. The NHS must address patient safety, data governance, the

potential for dehumanisation of care, the health and socioeconomic inequalities impacting on accessibility of new technologies, and must encompass the needs of patients, carers, healthcare staff and organisations. Within this thoughtfully considered framework, the Review proceeds to map the digital healthcare future. That’s no easy task: technological changes are not always predictable, smooth, or welcome, and they sometimes unleash the unexpected. The advances will come through three overarching technology groups identified for physical health: Digital Medicine, Genomics, and AI and Robotics. The Mental Health groups differ somewhat: Digital Medicine, Genomics, and Systematic Data Recording, Processing and Sharing. In the online version of this piece, I consider some of the specific elements of the Review, in particular, electronic health records (EHRs) and the use of natural language processing. From a psychological perspective, the interplay between mental and physical health means that what happens in each domain can be relevant to the other: identifying a genetic risk for an individual will have psychological ramifications, or people with depressed affect may not adhere to treatment for their diabetes. Psychologists will need to straddle the divide. Over many decades now, psychologists have been developing digital tools to meet healthcare needs, providing information resources, assessments, treatments and other applications. They have adapted as technologies such as virtual and augmented reality have become increasingly sophisticated, connected and integrated into the daily living of users. The ongoing digital revolution and its impacts in healthcare (and elsewhere) also constitute a psychological

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revolution – such developments almost invariably involve significant transformations of thinking, actions and feelings, and their interactions as well as the direct and mediated relationships people have with technologies, and much else. Psychologists will need to enter their practice ‘digitally empowered’ and ready to use the resulting opportunities and challenges in applying psychology in creating

new technologies and in developing applications and adaptations that exploit the benefits these can bring. Psychologists can make tech relevant to people’s needs, identifying harmful psychological impacts and, if necessary, arguing for modification or its removal on psychological grounds. The digital future is thus also a psychological future, with potential benefits for all using healthcare services. Judging by

the past, the future will bring opportunities for both innovative psychological applications and wider psychologically-informed roles in digital healthcare. Michael Berger Emeritus Professor of Clinical Psychology Royal Holloway, University of London He is a recipient of the Society’s Lifetime Achievement Award: see p.18

Ending benefit sanctions for all?

Last month’s letter from Laura Ramsay, ‘Semantic revolution, or knowledge evolution?’, was in fact co-authored with Dr Jamie Walton. Apologies for this omission. Letters online: Find more letters at www.thepsychologist.org.uk/debates

Deadline for letters for the June print edition is Friday 3 May 2019. Letters received after this date will be considered for the following month and/or for publication online. Email letters to psychologist@bps.org.uk with the subject line ‘Letter to the editor’.

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Tim Sanders/www.timonline.info

I was pleased to read that the British Psychological Society, along with eight other leading mental health organisations, have signed a consensus statement (see tinyurl.com/y3mldglh) that ‘everyone living with a mental health condition should be supported to attain financial security’, and that ‘Neither conditions nor sanctions have been shown to work or to be safe for people with mental health difficulties, and as a result we believe they should be stopped’. This is a welcome step, but does it go far enough? The current benefit sanctions scheme started with the Conservative government in 1986 and the introduction of Job Seeker’s Allowance (JSA), which increased the monitoring of claimants. The New Labour government elected in 1997 introduced the New Deal programmes, which became increasingly compulsory for more and more claimants, who faced benefit sanctions if they did not meet job-search requirements. The Welfare Reform Act 2012, introduced by the coalition government, increased the number and severity of benefit sanctions for JSA and certain disability claimants up to three years. The justification was to promote positive behavioural change and incentivise job searching. The number of sanctions peaked at over a million in 2013, and then fell due to fewer people participating on the Work Programme (rather than greater compliance). Private providers were more likely to issue sanctions than other providers. There is some evidence that many claimants are sanctioned through lack of understanding of what is required of them to avoid a sanction, rather

than deliberate non-compliance. Furthermore, there is evidence that claimants found it difficult to comply through, for example, not having enough money to attend appointments, having to apply for too many jobs per week, and clashing appointments. There may be a wide range of reasons why people are not in paid work, such as structural unemployment, ill health, caring responsibilities, disability, technological change, market failure and employer discrimination. The Mental Health Foundation estimate that 85 per cent of people out of work have experienced mental health problems. Research from the Welfare Conditionality Project led by the University of York broadly found that welfare conditionality is ineffective in assisting and progressing the unemployed into the paid labour market, and that it can lead to counterproductive negative behaviour – disconnection from the social security system, increased poverty, worse ill health and increased risk of survival crime. Indeed, there is considerable evidence that many benefit claimants who have been sanctioned have suffered significant hardship, with many ending up relying on foodbanks, becoming homeless and engaging with begging and crime. Such a predicament would undoubtedly worsen existing mental health problems and increase the likelihood of claimants developing mental health problems. Therefore, is there not a psychological argument for the end of benefit sanctions for all claimants? Stephen McMurray Edinburgh

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the psychologist may 2019 letters

Fighting the stigma of Borderline Personality Disorder Working as a Behaviour Advisor for Accomplish, a large care provider, I support many people in our mental health services with a diagnosis of Borderline Personality Disorder (BPD). I am writing this letter to once again highlight the stigma that is attached to BPD and to advocate for more research, so that the people who have been diagnosed with one of the most misunderstood, misdiagnosed and stigmatised conditions can gain the help they desperately need. I’m sure most psychologists would agree how challenging the concept of BPD is. We have failed to arrive at an adequate definition of the term ‘self’, but define ‘personality disorders’ as disturbances in a person’s experience of self (Moorey et al., 2008). With this vague diagnosis, it is somewhat understandable where the stigma has derived from, however, what I find most perplexing, is how Personality Disorder is included in the national service framework for mental health, yet there are people diagnosed with BPD who are passed from pillar to post with no mental health practitioners wanting to accept responsibility for their care. Dr Steve Hinder, a psychiatrist for Birmingham community health care, recognises this and in a recent interview described how the diagnosis of BPD tends to place people into a ‘black hole’ where no one knows how they can help the person. For me, the ‘black hole’ which Dr Hinder described became evident when a person I support with a BPD diagnosis was informed by a mental health practitioner that their presentation didn’t meet the criteria for support because they were showing behavioural rather than mental health difficulties. I found this explanation very challenging; especially considering the very definition of BPD is ‘emotional instability, disturbed patterns of thinking, intense but unstable relationships with others and impulsive/self-destructive behaviour e.g. self-harm and binge drinking’. Personally, I felt this explanation was dismissive and inadequate, and after performing a literature review to establish if there was question about BPD being a behavioural or mental health difficulty, the practitioner’s unwillingness to help which I suspected this person experienced was evidenced. What was also evident was the amount of research highlighting the stigma attached to a BPD diagnosis. In a recent study, Rusch et al. (2006) found that patients with a diagnosis of BPD are vulnerable to high stigmatisation in comparison to patients with other psychiatric disorders, including other types of personality disorder. Rusch et al. (2006) argue that this stigmatisation is the result of the severity of their conditions, interpersonal difficulties and visible devaluating signs, such as self-mutilation scars. It was also evident from the study that the widespread idea that

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from the chief executive Over recent weeks and months, an advisory group of members drawn from across the BPS has been working to develop a comprehensive survey of our membership. I’m delighted that we’re now almost ready to launch the survey, which will cross the boundaries within our discipline and touch on all areas of education, practice and research. If we’re to be successful on our journey to becoming a Society which is led by its members and delivers the outcomes which you all want, it’s vital that we have a deep understanding of what that actually is. This survey will produce a detailed evidence base that we can use to inform and improve our work influencing policy and the support that we offer as a professional body. We are of course aware of increasing workloads and demands, organisational cultures that may not be the most supportive, and examples of poor leadership within our sector. We’re aware of these because you tell us, and we often read about it in these pages. But if we’re going to advocate for and ultimately achieve positive change in these areas, then we need to be able to back our views up. A survey on this scale isn’t something which we’ve done before, so we’ve commissioned the Institute for Employment Studies (IES) to conduct it for us. As well as being industry experts, the team we’ve worked with has been led by a psychologist and BPS member. IES will be contacting BPS members by email or letter shortly, inviting you to participate in an online survey. All responses will be confidential, and your data will be held in accordance with GDPR regulations. The survey will cover key themes including management and leadership, workload, and diversity, equality and inclusion. It will ask about your career journey, and your workplace wellbeing. While the survey has been carefully designed to capture the broad issues which affect all psychologists, there will also be the opportunity for you to respond on specific issues, whether you are a practitioner, academic, student or even work outside of psychology itself. As with any survey, its validity depends on the number of responses, so it would be great if as many members as possible give us their views. Please respond and give us the opportunity to represent you as best we can. As ever, I welcome your thoughts and comments so please do get in touch. Sarb Bajwa is Chief Executive of the British Psychological Society. Contact him at Sarb.Bajwa@bps.org.uk

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the behaviour of patients with PD is deliberate and within their control also contributes to the judgemental and rejecting attitudes that people with BPD face. Considering how much our knowledge of mental health has developed, I’m sure you’ll agree that the existing stigma is unacceptable. Together we need to help fight this stigma and call for more research to be done to encourage a movement towards a more understanding, accepting society. Lydia Parkhill Droitwich

References Moorey, J., Davidson, K., Evans, M., & Feigenbaum, J. (2008). Psychological theories regarding the development of personality disorder. In M. J. Sampson, R. A. McCubbin, & P. Tyrer (Eds.), Personality Disorder and Community Mental Health Teams: A Practitioner’s Guide. Chichester, England: John Wiley & Sons, Ltd. Rüsch, N., Hölzer, A., Hermann, C., et al. (2006). Self-stigma in women with borderline personality disorder and women with social phobia. The Journal of Nervous and Mental Disease, 194(10), 766-773.

Research in Worktown is alive and well

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We welcome the recent article ‘Mass Observation – the science of ourselves’ from Graham Davies and Alan Costall (March 2019). As they describe, Tom Harrisson moved to Bolton in 1936 to turn his anthropological skills onto the northern working class in Worktown (Bolton). Here at the University of Bolton, we have the Centre for Worktown Studies (led by Professor Robert Snape), where current research projects in Worktown encompass social and cultural history, creative writing, drama, design, documentary photography and well-being. The Centre recognises that Mass Observation’s 1938 survey of happiness in Bolton was one of the most innovative psychological explorations of British attitudes before the Second World War. In 2014, two of us (Sandie McHugh and Professor Jerome Carson) replicated this survey in collaboration with The Bolton News. Boltonians therefore had the opportunity to express their views on happiness, just as their predecessors had done 76 years earlier. Results from the comparative study ‘Happiness then and now’ were published in The Psychologist in May 2016. This, along with research on leisure, enjoyment and a special section on children were published as an in-depth study of the town in an edited book in 2017. The idea of Worktown has been widely used in public engagement projects undertaken by the University and has proved to appeal across socio-economic and cultural

population groups. A current doctoral study through the Octagon Theatre, for example, is using Worktown to enhance subjective well-being amongst socially disadvantaged women. This project has introduced them to the lives of women cotton operatives in the inter-war years and has enabled them to re-interpret Mass Observation’s documentation in

various forms of cultural production. Its outcome will inform current thinking on the value of community history in improving mental health. Research in Worktown is very much alive and well. Sandie McHugh Professor Robert Snape Professor Jerome Carson University of Bolton

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the psychologist may 2019 letters

Reviewing UK hate crime laws

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Tim Sanders/www.timonline.info

The Law Commission are currently working on a review of UK hate crime law, looking at the current laws in place, as well as reflecting changes in society to keep up with modern living. This review could impact across many areas in psychology, as well as the UK in general. I have been working with Citizens UK, keeping involved in the review and coming together with others in consultation meetings ahead of the official launch of the review in March this year. In the UK, we have hate crime laws which exist to protect individuals who have been targets of crimes because of particular characteristics they possess: disability, race, sexual orientation, transgender identity and religion. This means that if a crime is committed and the motive for that is determined to be because of one of these characteristics, then it will be investigated, tried and sentenced according to guidelines for hate crime offences. Recently, with public attitudes and social movements such as the #MeToo campaign, there has been debate around whether other characteristics, such as age and gender, should also be considered under the hate crime Laws. Following a campaign from Citizens UK (Nottingham Citizens), Nottingham Police trialled misogyny as a hate crime from 5 April 2016. By the end of December 2016, they had received a total of 31 reported misogynistic hate crimes and 48 reported misogynistic hate incidents, totalling 79 reports under the trialled definition in the space of six months (see tinyurl.com/y4h9uxz3). Since this finding, other police forces have also taken on treating misogyny as a hate crime, while other forces have adopted this approach for different factors, including identifying as a â&#x20AC;&#x2DC;gothâ&#x20AC;&#x2122;. This wave of police forces trialling new hate crimes, combined with social movements, raised the idea in Parliament of a review on the UK hate crime laws to be carried out by the Law Commission â&#x20AC;&#x201C; a separate organisation who carry out research, using experiences and data from across the country, to create a final report, which the government then considers to guide any changes in laws and legislation. As a result of these events, the UK Government commissioned the Law Commission to launch a review looking into the existing categories covered under hate crime law, as well as whether there are others which need to be added. The review itself will not mean the law has to change, but is instead used to advise the government when they are making decisions. This means that the findings presented in the report may not translate directly into changes that are made, however, recommendations from previous reviews have been taken up in roughly 70 per cent of cases and the reports often have a wider impact on society beyond just changes in law. There are a number of organisations already involved in the review, including Citizens UK, Dimensions, the Fawcett Society, Stonewall, the Mental Health Foundation,

naming only a few, and many more are getting involved as the review continues. I have been involved through Citizens UK, doing research into misogyny and sexual harassment for the past three years, but the Law Commission are also looking at research or personal experience stories of the impact of crimes motivated by any of these characteristics to feed into the review and give a national picture. This review could have implications in psychology wider than just support for victims of these forms of hate crime, with mental health, social psychology and forensic psychology being the obvious areas to be impacted, and a ripple effect filtering across into other areas of psychology as well. The hate crime review may only be in the early stages at the moment, but this is definitely work to keep your eyes on as it develops over the next couple of years (see tinyurl.com/yyekds23). Natasha White Student, Middlesex University

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How can we embed psychology in public policy? We hear from members of the British Psychological Society’s Policy Team…

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As the Society’s Director of Policy, I’m absolutely thrilled to be introducing the newly expanded Policy Team to our members. The new Advisors who have joined in 2019 will work closely with the existing members of the team to deliver a step change in the level of impact that psychology will have on policy making. Any government serious about improving the lives of the public and understanding why intractable social problems persist must ensure that their policies and interventions are based on an in-depth understanding of human behaviour. To that end, a core objective of the Policy Team is to ensure that quality psychological evidence is routinely placed at the heart of government. We do this in a number of ways. It may be bringing together relevant expertise from across the discipline to develop policy reports and position papers, responding to a consultation or holding events in Parliament to share our evidence directly with those who hold the power to make change. It may be as simple of sharing the name of a relevant expert with a parliamentary researcher. Policy influencing is not a straightforward or one-off process. To be most effective we need to focus concerted attention on a small number of priorities and we need a

range of tactics. The newly expanded team means each Advisor can now work with members on developing and delivering specific policy change objectives. The new skills they have brought will complement those of the existing team, to enable us to develop creative and effective strategies. The work of the five Policy Advisors ‘with portfolio’ is closely integrated with the work of our Head of Research and Impact, Dr Lisa Morrison Coulthard, who is leading a strategy to inspire and showcase excellence and impact in psychological research. Our policy work also goes hand in hand with our professional practice work, led by Hannah Farndon, who is working to both shape and respond to the changing environment for practitioner psychologists, and to deliver guidance to support them to deliver the highest quality of service. The BPS is committed to getting the voice of psychologists heard in the corridors of power and seats around the tables that matter. At the same time, we will get more psychological evidence in the inboxes and on the desks of those with influence. We will do this to ultimately deliver change for our members and the people and communities we work with. Watch this space… Kathryn Scott, Director of Policy kathryn.scott@bps.org.uk

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the psychologist may 2019 public policy

A more personalised psychological approach Sabrina Kamayah, Senior Policy Advisor Having studied psychology in my first degree, I feel like I have come back home. It is a brilliant time to join the Society, and be a part of its strategic journey to grow and embed the voice of psychologists and psychology in the public and political space. We have an active role in shaping health and care, by advancing the use of psychological evidence for the benefit of the public. Mental health has always been an important area for me, on both a personal and professional level. To underpin this, I have always approached my policymaking through the lens of equality and human rights. I value the integral role psychology plays within the health and care system, which can often be overshadowed by the biomedical model. It is time to move away from a dominant focus on the medicalised approach towards a more personalised Getty Images

Psychologists are looking to develop a focus on wellbeing

psychological approach to care, with a focus on wellbeing. The Society membership has a wealth of psychologists representing different therapeutic modalities. Our team must use this expertise by connecting people… I plan to join networks and build relationships with mental health leads across government, NHS England and other important stakeholders. Meetings on the horizon include government-working groups on suicide Sabrina Kamayah and self-harm, the integration of mental health and physical health, and on children and young people’s mental health. Developing the Society’s position on prevention in advance of the Government’s Green Paper on Prevention, and working in collaboration with psychologists, and national stakeholders to create our vision for a psychologically informed workforce, are just some of the areas I will be working on. Psychologists are all about prevention, and have an integral role in the workforce to meet a significant skills and knowledge gap in the NHS. How do you think the public policy team and psychologists should work together going forward? I would love to hear your views.

Stay at the crease Andrew Baldwin, Policy Advisor (Work) A decade ago I worked in Westminster for a Member of Parliament who was either excellent or terrible, depending on which constituents you spoke with. Every morning, I would sift through the mountain of correspondence sent to the Parliamentary office from lobby groups, charities and businesses, each one arguing vociferously that their issue was the most important issue facing the nation. I sorted it into three piles – recycle, keep and action. When considering how best to influence public policy I invariably return to this memory, because for any policy promotion to be effective it absolutely has to pass the researcher test. In the two seconds it takes to assess your report will the MP’s staff see the evidence, the recommendations and the passion you put into making it happen, or will they just see another contender for the recycling bin? How do you increase the likelihood of that researcher considering your report for longer? To answer this, remember that policymaking is a remarkably slow process – recommendations can take years before they’re picked up by Governments. I liken it to test cricket – attempting to slog every delivery to the boundary will not work… it will just lead to

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more reports in the recycling bin. Instead, we need to think long term – stay at the crease, play for time and identify the types of delivery you’re going to hit. To that end I have been working with the Society’s Division of Occupational Psychology to narrow down the literally thousands of issues related to the four fields of practice, work and the environment, the individual, training and the organisation. From that, we can identify overarching themes to realistically influence on (the deliveries we can hit), examples of which could include neurodiverse conditions, career development or wellbeing issues. That’s not to say we won’t take opportunities outside of the overarching themes (a cheeky single here and there). Capitalising on an opportunity when it presents itself, and being in a position to react to events, is vital. Part of my role will be to spot these and work with you to make the most of them. For me to advocate, though, I need your help. Please do get in touch with ideas and suggestions. Working together we can embed psychology in public policy, maintaining a consistent, credible and transparent approach. Just be warned it may take more than a couple of innings!

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Do what we can, even if we cannot do much Nic Murray, Policy Advisor (Social Justice)

Nic Murray

Working in mental health policy for several years and taking part in debate and discussion on figures and evidence, I’m sometimes reminded of a cartoon from the Spanish newspaper El País. In it a woman is exclaiming ‘But there are people behind those statistics’, to which a man remarks ‘well they need to get out of there’. Thankfully I’ve never encountered a policy maker this ruthless, but I am minded that we always need to think about the people behind any figures and evidence, and look beyond this to consider their lived experiences and contexts. As a policy advisor focusing on social justice issues I believe that psychology has a lot to say about these people, and what their lives and social conditions look like when existing policy places barriers before them or negatively impacts on their mental health and wellbeing. Most clearly needed in this space to date has been the use and misuse of psychological evidence within the benefits system. The Society has been outspoken in its condemnation of the use

of sanctions against benefits claimants since 2017, reiterating these calls this March in a joint statement with a range of other professional bodies and mental health charities. This is one area in which both the Society and I recognise there is a lot of work to be done. It will remain a key aspect of my role going forward, alongside other key social justice and equalities issues such as policy work around issues facing marginalised and vulnerable populations. This will involve work with networks like Women and Equalities, Male Psychology, Forensic, Community Psychology and certainly many more in order to ensure that we harness best evidence and insight available within the society to support the wellbeing of these groups. The late psychologist David Smail once wrote ‘It is incumbent upon us to do what we can, even if we cannot do much’. The Society members that I have met since starting this role have expressed a real enthusiasm and desire to engage with our growing capacity for policy influence. I hope many more share these views… the Policy Team are here to enable all of us, and psychology as a whole, to do a lot more to influence policy.

A breadth of expertise and evidence Nigel Atter, Policy Advisor (Children and Young People’s Mental Health) As a policy advisor sat in front of a parliamentarian, you quickly have to adjust the way you engage. MPs often want to know how to fix a problem, in the shortest time, and at the lowest cost. These questions often don’t have simple answers. But as long as we are presenting evidence-based responses and having those conversations, this allows us to ask MPs to raise awareness of certain issues through parliamentary questions. I’m leading work on children and young people’s Getty Images

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mental health, voted as a policy priority by the Society’s Senate last year. This builds on previous work: I had developed a small expert reference group and we published two briefing papers, one on children and young people’s mental health in schools and colleges and the second on children in care and the link to a risk of offending. Later that year the government published a green paper on improving children and young people’s mental health and put out a call for responses. I, along with input and evidence from our members, wrote a draft response to that. Just after the green paper was published the Health and Education Select Committee announced a joint inquiry into the implementation of that green paper which we also took part in. The committee quoted the evidence the BPS submitted on six separate occasions in that inquiry, which I was delighted with. We’re often asked to show how much impact we’re having in policy, and that’s a difficult thing to do. There aren’t many tools around which can measure that. We can see if we get mentioned on social media or in the press, and we can also look at where the evidence developed by our members is mentioned. We are also engaging with parliamentarians, and having

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the psychologist may 2019 public policy

our evidence quoted by the Health Select Committee helps us get our foot in the door and start having conversations with civil servants and parliamentarians. We’ve also found that building networks with other stakeholders has been very useful – for example we’re part of the Children and Young People’s Mental Health Coalition, chaired by Professor Dame Sue Bailey, which comprises 80 organisations. When the coalition responds to an issue, I will receive the response to add some of the Society’s evidence into it. That evidence which practitioners and researchers provide to us, and of course psychology more

broadly, is so diverse. There is a breadth of expertise and evidence in the field from clinical forensic and counselling psychology, researchers in education and developmental psychology, and those who work in specialist services. It has been helpful to establish the All Party Parliamentary Group for Psychology, which gives us a voice in parliament and the ability to share psychological evidence on many different topics in Westminster. This has also allowed us to hold meetings with people like James Morris MP, who was deputy chair of the All Party Parliamentary Group for Mental Health.

Politics is personal Saskia Perriard-Abdoh, Policy Advisor (Health) No matter where you stand on the political spectrum, it’s easy to get jaded by the state of politics nowadays. My overarching goal as part of the policy team is to embed the notion that ‘politics may be confusing but psychology is here to help’ in the minds of policymakers. From my perspective, policy clarifies the social contract that exists between people, elected officials and government institutions while providing measures of accountability to ensure that this obligation is being met. Despite how impersonal this concept might seem at first glance, it is individuals who choose which policies to develop, which legislations to lobby for, and which voices are considered before these decisions are finalised. Understanding these people, how they work, and what pressures they work under is therefore incredibly important if we want policies to be developed with a sound understanding of psychological evidence. Given the wide range of political and social issues that jockey for attention, policymakers often find themselves overwhelmed by a sheer flow of information. As a result, important issues and valuable perspectives can get filtered out of mainstream policies, not because of an unwillingness from politicians to engage (though of course that can also be the case), but rather because there simply isn’t enough time for them to familiarise and immerse themselves into new issues that are beyond their fields of interest. In other words, policy makers rarely go out of their way to find new problems and causes to champion if the solutions aren’t easily seen. That being said, if the moment is right, the message is clear, and most importantly, if there are evidence-based solutions and experts willing to take the time to explain them – then change can happen very quickly. Given the breadth of psychology as a discipline and its focus on understanding the ‘why’ of things

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rather than simply the ‘how’, I believe psychologists are uniquely positioned to influence policy and connect decision-makers with great ideas. There is already a lot of great work getting done on that front and I’m really looking forward to helping you embed this work into tangible policy outcomes. In sum, politics is personal… but what can be more personal than one’s health, sense of self and relation with the rest of society? For this reason, I am delighted that I’ll be working closely with psychologists from the Divisions of Neuropsychology, Health Psychology and Sports and Exercise Psychology on a range of policy areas which connect to the health policy portfolio. I have had already had the pleasure of meeting and having conversations with many members but, to echo many of my colleagues, please get in touch. There are exciting times ahead.

Saskia Perriard-Abdoh

Find out more about the work of the Society’s Policy Team via www.bps.org.uk/policy-research-and-guidelines At the Society’s Annual Conference in Harrogate on 1 and 2 May, The Psychologist will be hosting a fringe event: ‘Political powers vs Ivory towers’. Find out more about the conference via www.bps.org.uk/ac2019

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The placebo effect Christian Jarrett digests ten amazing findings

Find our Research Digest at www.bps. org.uk/ digest Editor: Dr Christian Jarrett Writers: Matthew Warren, Emma Young and Jesse Singal Full reports and much more on the Digest website

he placebo effect usually triggers an eyebrow raise or two among even the most hard-nosed of skeptics. We may not be able to forecast the future or move physical objects with our minds, but the placebo effect is nearly as marvellous (Ben Goldacre once called it the ‘coolest, strangest thing in medicine’). The term ‘placebo effect’ is short-hand for how our mere beliefs about the effectiveness of an inert treatment or intervention can lead to demonstrable health benefits and cognitive changes – an apparently incontrovertible demonstration of the near-magical power of mind over matter. It’s not literally magic, of course. Our beliefs are the subjective echo of physical processes in the brain – and it’s this constellation of neurochemical and electrical events, and their downstream effects, that underlies the placebo phenomenon (in some cases the placebo effect can also be interpreted as a form of conditioned response, in which a learned physiological reaction occurs in the absence of the original trigger). There is another angle to this topic. To research psychologists, the placebo effect isn’t always a phenomenon of wonder, but a methodological nuisance. Researchers must go to extreme lengths to rule out the influence of participant expectations, so as to establish which observed effects are truly attributable to an intervention. Here, in a celebration of the mysterious and maddening placebo effect, and to help inspire future research into this most fascinating aspect of human (and animal) psychology, we digest 10 amazing placebo-related findings (find hyperlinks to studies in the online version):

It works even when you know it’s a placebo 22

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For the placebo effect to occur, it’s usually considered that deception is required – tricking the patient into thinking that an inert treatment is actually a powerful drug or

similar. It’s this need for trickery that has long meant the deliberate inducement of placebo effects in mainstream medicine is seen as unethical. Nearly ten years ago, however, researchers showed that people with irritable bowel syndrome showed greater improvement after being given a so-called “open placebo” that they were told was completely inert, as compared to receiving no treatment. Presumably some residual belief and expectation of an effect survives being told that the treatment is physically impotent (or there is a condition response to the placebo that does not require positive beliefs). More recent research has since shown benefits of open placebos for many other conditions including back pain and hay fever. Open placebos ‘bypass at least some of the conventional ethical barriers’ to the clinical use of placebos, according to some experts. Others however have highlighted the lack of suitably robust research in this area, and it’s worth noting there have been some null findings – for instance, open placebos failed to speed up wound healing.

Branding, colours and medical paraphernalia can all boost it

Putting aside open placebos, there’s evidence that different forms of deceptive placebo vary in their effectiveness. The more powerful we imagine their effect will be, the larger the benefit. This means that four placebo pills have a larger effect than two; and placebo injections (filled with nothing other than saline solution) are more powerful than pills (in fact, in the context of osteoarthritis, a placebo injection was found to be more effective than a real drug). Also – depending on the condition being treated – pills of certain colours and descriptions are more effective than others, such as blue placebo pills making better sedatives than pink ones, and branded placebo pills being more effective than those without any labelling. The influence of the credibility of a

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the psychologist may 2019 digest given placebo on its subsequent effectiveness may help explain one of the most astonishing demonstrations of the placebo effect that I’ve come across. It involved ‘placebo brain surgery’ – and what could elicit a greater hope for a treatment effect than the elaborate paraphernalia and protocols involved in experts operating on your brain? Specifically, the research showed that patients with Parkinson’s Disease who undertook a form of placebo brain surgery (supposedly, but not really, involving the injection of stem cells) showed greater symptom improvements than those patients who received the stem cell treatment, but didn’t think they had. ‘The placebo effect was very strong in this study,’ the researchers said, ‘demonstrating the value of placebo-controlled surgical trials’.

Some people are more prone to it

Certain personality traits are associated with it being more likely that a person will experience the placebo effect. This is logical since the placebo effect depends on our beliefs and expectations, which some of us may subscribe to more readily and enthusiastically than others. Among the results in this area, optimists are more responsive to analgesic placebos, as are people who score higher for emotional resilience and friendliness (this last finding may relate to the social dynamic involved in the elicitation of the placebo effect by physicians). Curiously, the traits related to placebo response vary according to the condition being treated – in the context of stress, for instance, one study found it was the more pessimistic and less empathic participants who showed a greater placebo response. Whereas personality traits appear to play an important role in the placebo effect, the evidence to date suggests that age and gender are largely irrelevant.

It’s not just about pain reduction – it can boost creativity and cognitive performance

We usually think of the placebo effect in the context of medical interventions and especially pain relief. However, there is growing evidence that the effect can also work in other ways, including enhancing our physical and mental performance. In terms of athletic abilities, various studies have shown placebo effects on speed, strength and endurance (in a placebo-like study, researchers asked cyclists to train to complete exhaustion and found they were able to persist significantly longer when their clocks had been secretly tampered with to make them run slow). In relation to creativity, one study found that people who smelt an odour that they were told boosts creativity went on to excel at tests of their creative performance as compared with a control group who smelled the same odour but weren’t told it had any special benefits. Another experiment involved participants receiving placebo noninvasive brain stimulation and performing a learning task. The placebo group thought their brains had been stimulated by a mild electrical current – in reality they hadn’t – and they were led to believe that this stimulation would boost their mental function. The placebo participants were subsequently more accurate in the learning task, and showed steeper reductions in their reaction times than control participants. ‘We conclude that experimentally induced expectancy can impact cognitive functions of healthy adult participants,’ the researchers said.

Some doctors are better at inducing it

As placebo effects depend on the patient believing in the power of the treatment being given to them, it follows that some doctors will be better placed to reinforce this hope and expectation than others. Research backs this up: a study that involved a placebo injection for the treatment of an allergic reaction found that symptom improvement was greater when the injection was given by a doctor conveying warmth and confidence. Feelings of similarity toward one’s doctor may also be relevant: another study found that subjective pain was lower after a medical procedure when participants thought they’d been paired with a doctor who shared the same values and personal beliefs as them.

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There’s even such a thing as placebo sleep

There is almost no end to the ways that the placebo phenomenon can manifest. In one particularly novel instance researchers tricked participants into thinking they’d had more sleep than they actually had, and then observed how this affected their performance the next day. The researchers achieved this deception by wiring their participants up to various physiological measures and then giving some of them false feedback on how much REM sleep they’d had. After hearing that they’d had an impressive amount of sleep, participants performed better on tests of language and arithmetic. Other imaginative examples and manifestations of the placebo effect include the study that showed health gains among hotel cleaning staff who had been reminded that their work counts as exercise, including in terms of improvements in their weight, body mass index, body-fat, waist-to-hip ratio and blood pressure. Another intriguing research finding, which might be explained by a kind of placebo effect, was that people who believe they exercise more than their peers

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tend to live longer, regardless of how much they actually exercise.

Animals seem to experience the placebo effect too

It is common in drug trials involving animals to compare an active treatment against a placebo, similar to the procedure in human drug trials. And when this is done, researchers have often observed that a significant number of animals in the placebo group show a treatment response, such as happened in a trial of an anti-seizure medication for dogs, and in a dietary intervention for muscle stiffness in horses. The problem with interpreting these kind of findings is that it’s possible the placebo effect really lies with the owners, who may interact with their animals differently when they believe they are receiving medial care or nutritional supplements. However, the argument that animals can demonstrate a kind of placebo effect is irrefutable in the context of lab studies involving rodents – in this case, researchers have paired an active drug, such as morphine, with a particular taste or smell, and then shown that the analgesic effect still occurs when the same taste or smell is repeated but without the drug. In this case the placebo effect is arising from a conditioned response rather than the animals’ expectations, but this is probably part of the placebo phenomenon in humans too. As Edward Ernst told BBC Earth: ‘A major chunk of what we believe constitutes the placebo effect has been in fact discovered in animals.’

It has an evil twin

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If the placebo effect occurs simply because you believe a given treatment will be beneficial, it follows that if you have negative expectations, this could result in a worsening of your symptoms. That’s exactly what researchers have found and they’ve called this the ‘nocebo effect’. The placebo effect’s twin is not to be sniffed at either. A meta-analysis in the context of analgesia (in which some participants are told that an inert cream or pill leads to increased pain in some people) found that the nocebo effect is roughly similar in size to positive placebo effects. Intriguingly, nocebo effects can even occur in the presence of real pain-relieving medications, not just inert treatments – in one study, participants were told that their pain would increase after an analgesia treatment was stopped. The physiological effect of the analgesia would normally persist, however in these participants it ended abruptly, as if the negative expectations had cancelled out the genuine analgesic effect. The real-life implications of these kind of findings are obvious – if nothing else, it’s probably worth taking care when you read the side-effects leaflet that came with your latest prescription.

The placebo effect is a bit of a pain for many psychology researchers

The placebo effect is fascinating in its own right, but for researchers interested in establishing the efficacy of psychological interventions, it can be maddening. The influence of expectations on our thoughts, feelings and behaviour is so powerful and pervasive that it complicates the interpretation of many studies, unless they are very carefully designed. In their 2013 paper titled ‘The Pervasive Problem With Placebos In Psychology’, a team led by Walter Boot at Florida State University argued that in fact many psychology studies (on things like brain training, expressive writing and internet therapy) do not do enough to match participants’ expectations across different conditions. They explain that simply having an active control condition is not adequate if participants in the control group do not expect it to have as beneficial or powerful an effect as participants in the intervention condition expect of their experience. The way around this, Boot and his colleagues explained, is to measure participants’ expectations and take steps to try to match them across control and intervention conditions as much as possible. ‘We are hopeful that, with better designs and better checks on placebo effects, future research will provide more compelling evidence for the effectiveness of interventions,’ they concluded.

The effect appears to be getting stronger

Curiously, it’s become apparent in recent years that the placebo effect is getting stronger – this has been shown for placebo antipsychotic medications, placebo anti-depressants, and – in the US only – for placebo analgesics. With regards to that last finding, research team leader Jeffrey Mogil told Nature News, ‘We were absolutely floored when we found out’. Specifically, in the 90s, they found that participants receiving an active drug reported 27 per cent greater pain relief than participants receiving placebo, but by 2013, the difference was just 9 per cent. One explanation is that drug trials have become larger and more elaborate, especially in the US, thus increasing the drama and intensity of the experience for participants only receiving placebo. Another possibility is that the general public has become more aware of the placebo effect – and of the idea that its impact on symptoms can be real (as reflected in less pain-related brain activity, for instance) and not merely illusory. That was the argument put forward by anesthesiologist Gary Bennett in the journal Pain last year. In fact, Bennett goes so far as to suggest that, because the term placebo now elicits such a strong placebo effect, its use should be dropped from drug trials. ‘The word ‘placebo’ should be avoided in all information and instructions given to the patients,’ he advises. ‘Patient instructions should have the goal of forcing the patient’s expectations to the form: “I may receive pain relief” vs. “I will not obtain pain relief”.’ However hard we try to control, conceal and comprehend the placebo effect, it looks certain it will continue to baffle and amaze us for a long time to come.

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the psychologist may 2019 digest

Living with Avoidant Personality Disorder In the ﬁrst study of its kind, researchers have asked people to describe in their own words what it’s like to live with Avoidant Personality Disorder (AVPD) – a diagnosis deﬁned by psychiatrists as ‘a pervasive pattern of social inhibition, feelings of inadequacy, and hypersensitivity to negative evaluation’. Like all personality disorder diagnoses, AVPD is controversial, with some critics questioning whether it is anything other than an extreme form of social phobia. Lead author Kristine D. Sørensen, a psychologist, twice interviewed 15 people receiving outpatient treatment for AVPD: 9 women, 6 men, with an average age of 33, and none of them in work. Writing in the Journal of Clinical Psychology, Sørensen and her colleagues said the overarching theme to emerge from the in-depth interviews was the participants’ struggle to be a person. ‘They felt safe when alone yet lost in their aloneness,’ the researchers said. Other key themes were participants’ ‘fear and longing’ (including the constant sense of having to put on a mask when socialising) and ‘a doubting self’ (including chronic insecurity, a fleeting sense of self, and constantly struggling to make sense of their own persistent insecurities). In the researchers’ opinion, the participants’ profound difficulties with their ‘core self’ and in their dealings with others do indeed correspond to ‘a personality disorder diagnosis’. [Christian Jarrett]

A study of thousands of volunteers from 36 countries has reproduced the ﬁnding that women prioritise earning capacity when appraising potential romantic partners, whereas men prioritise physical appearance – with countries’ levels of gender equality being irrelevant to the pattern. (PsyArXiv)

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Our sensitivity to the other people’s facial expressions of emotion changes through life, according to a study of thousands of volunteers from around the world. While our sensitivity to fear and anger increases through early life before peaking in middle age and then declining, sensitivity to other people’s happiness is sustained through life and into old age. The results could help explain why older people tend to report feeling happier more of the time than younger people. (Journal of Experimental Psychology)

Mirror neurons – brain cells that ﬁre when we perform an action or witness someone else performing that action – have previously been described as providing the neural basis for human empathy. However, a new meta-analysis and systematic review of all English-language published studies into mirror neuron activity and empathy levels has found that there is only weak evidence for a link between the two, and no evidence for the cells playing a causal role. (PsyArXiv)

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Dads get sad too Viren Swami withdrew from his newborn son. Here, he considers the lack of research and support around postnatal depression in fathers.

’m not sure I instantly loved my newborn son the way my wife did, the way I’d been expecting to love him myself. As the days passed, my estrangement grew. I felt anxious at the thought of having to spend time with my son, to hold him and be with him. Every time he cried in my arms, I felt as though he were saying he hated me, as though he were rejecting me. I began to feel isolated and alone, and in response I withdrew – from both my son and my wife. There were days I avoided them entirely, shut myself off completely, and ended up hating myself when I did. I felt useless and unworthy to be a part of the family, unfit to be a father. I struggled to find joy in anything I did. Lethargy set in. I cried a lot. Some days I stayed in bed and other days I hardly slept. I often overworked to the point of burning out. I simply couldn’t cope, and yet I never thought of asking anyone for help.

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Postnatal depression Postnatal depression is well researched in new mothers. Distinct from the ‘baby blues’ – typically characterised by mood swings, anxiety, irritability and insomnia in the days following birth – postnatal depression is a non-psychotic depressive disorder that occurs after the birth of a child (O’Hara & Wisner, 2014), sometimes up to a year after delivery, though it is most commonly diagnosed within the first three months post-birth (Stuart-Parrigon & Stuart, 2014). Prevalence estimates vary because studies often use different assessment criteria and postnatal timeframes, but meta-analyses suggest an overall prevalence of maternal postnatal depression of between 6 and 13 per cent (Gaynes et al., 2005), with substantially higher estimates of up to about 20 per cent in lowand middle-income countries (Fisher et al., 2012). In

short, we know that depression is relatively common in women after giving birth. Researchers also know a good deal about the impact of maternal depression on mother and child outcomes (Lee & Chung, 2007). For example, postnatal depression in new mothers is associated with poorer mother–child attachment in both the short and long term (Figueiredo et al., 2009) and shorter breastfeeding duration (Henderson et al., 2003). It is also associated with negative child development outcomes, including cognitive, language and behavioural problems (Netsi et al., 2018). Maternal depression also carries a heavy long-term economic cost to society: in the UK, the average cost of one case of maternal depression is around £74,000, with the bulk of the costs relating to adverse impacts on the child (Bauer et al., 2014). The good news is that there is long-standing guidance from national bodies in the UK about what services are needed for mothers affected by depression, how services should be organised, and what they should provide. Conversely, paternal postnatal depression has not received the same level of attention from researchers and practitioners. One reason for this is that postnatal depression was historically associated with sex-specific hormonal and biological changes associated with giving birth, which in turn meant that new fathers were thought to be less susceptible to, perhaps even immune from, depression after the birth of a child. Additionally, stressors that frequently contribute to postnatal depression – including delivery complications, unsuccessful breastfeeding, sudden changes in normal daily activities, lack of sleep and changes in financial security and familial relationships – were thought to only or disproportionately affect mothers. Perhaps unsurprisingly, until relatively recently paternal postnatal depression simply did

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the psychologist may 2019 postnatal depression in fathers

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Illustrations: Karin Creemers, Saulgond France www.karincreemers-illustrator.com

This is difficult to write: the day my son was born, I didn’t feel the elation, the overwhelming joy I’d been expecting. Something was missing – a sense of connection to my newborn son maybe, but something more than that, too.

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not figure strongly in scholarly research, let alone practitioner guidance. Fortunately, that has begun to change. There is now much wider recognition that the psychosocial changes that affect mothers after birth can also have a detrimental effect of the mental health of new fathers (Philpott, 2016). In fact, recent studies have reported prevalence estimates of between 8 and 11 per cent for paternal postnatal depression (Glasser & Lerner-Geva, 2018; Paulson & Bazemore, 2010). Many factors have been identified as contributing to paternal postnatal depression, of which the most common is maternal postnatal depression (Edward et al., 2014; Zhang et al., 2016): fathers whose partners had postnatal depression were estimated to have a 2.5 times higher risk of depression six weeks after the birth of a child (Matthey et al., 2000). In addition, a previous history of mental health disorders, particularly depression, poses a Key sources greater risk for developing paternal postnatal depression (Wee et al., Chin, R., Daiches, A. & Hall, P. (2011). 2011), most likely because of a A qualitative exploration of first-time combination of predisposing genetic fathers’ experiences of becoming a factors and the postnatal period father. Community Practitioner, 84, acting as a stressful life event that 19–23. Darwin, Z., Galdas, P., Hinchliff, S. et al. triggers the recurrence of depressive (2017). Fathers’ views and experiences symptoms (Philpott & Corcoran, of their own mental health during 2018). pregnancy and the first postnatal year. Other key factors contributing BMC Pregnancy and Childbirth, 17, 45. to paternal postnatal depression Glasser, S. & Lerner-Geva, L. (2018). include discrepancies between Focus on fathers: Paternal depression in the perinatal period. Perspectives the expectation and realities of in Public Health [Advanced online childbirth and the postnatal period publication]. (Edhborg et al., 2015). In particular, Paulson, J.F. & Bazemore, S.D. (2010). fathers who experience greater Prenatal and postpartum depression difficulties with childcare than they in fathers and its association with initially expected show greater maternal depression: A meta-analysis. Journal of the American Medical symptoms of postnatal depression Association, 303, 1961–1969. (Gross & Marcussen, 2017). This Philpott, L.F. (2016). Paternal postnatal is perhaps unsurprising given that depression. Primary Health Care, 26, many new fathers say they do 23–27. not receive adequate information Price, R. (2018). A project to support about appropriate parenting skills fathers with paternal postnatal depression. Journal of Health Visiting, 6, and techniques, particularly from 380–386. family-centred services and their Swami, V., Barron, D., Smith, L. & own fathers (Barclay & Lupton, Furnham, A. (in press). Mental health 1999). Likewise, antenatal care is literacy of maternal and paternal often directed at mothers, and lack postnatal (postpartum) depression in of information and preparation British adults. Journal of Mental Health. Wee, K.Y., Skouteris, H., Pier, V. et al. for pregnancy and childcare are (2011). Correlates of ante- and postnatal important risk factors for postnatal depression in fathers: A systematic depression in first-time fathers review. Journal of Affective Disorders, (Boyce et al., 2007). Difficulties 130, 358–377. managing childcare responsibilities Whitelock, A. (2016). Why do health with a return to work, feelings of visitors screen mothers and not fathers for depression in the postnatal period? isolation (and even jealousy toward Journal of Health Visiting, 4, 312–321. their babies) as family attention is diverted to the child, and difficulties Full list available in online/app version. with the marital relationship can all also contribute to paternal postnatal

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depression (Gawlik et al., 2013; Goodman, 2005; Nishimura et al., 2015). Some of these factors are specific to fathers, particularly the relatively speedier return to work among fathers compared to mothers and societal expectations that fathers both provide financial support for the family while playing an active role in childcare and providing emotional support to their spouses (Darwin et al., 2017; Edhborg et al., 2015; Halle et al., 2008). Self-blame and feelings of failure for the loss of intimacy and sex with partners can also add to fathers’ feelings of distress (Morse et al., 2000). There is also some evidence that paternal postnatal depression is related to hormonal changes, particularly decreases in testosterone, prolactin and oestrogen, in men during the partners’ pregnancy and the postpartum period (Sundström Poromaa et al., 2016). Finally, fathers also report more difficulties developing emotional bonds with their children compared to mothers, which may increase feelings of helplessness (Anderson, 1996) and contribute to feeling like a bystander to the motherinfant bond (Chin et al., 2011). There is also now much wider recognition that paternal postnatal depression can have detrimental impacts not just on fathers themselves – most notably higher suicide risk (Quevedo et al., 2011) – but also on father–child bonding. For example, paternal postnatal depression is associated with poorer father–infant attachment (Ip et al., 2018) and with lower willingness to participate in child-rearing and lower engagement in enrichment activities with the child (Paulson et al., 2006). Depressed fathers are also much more likely to use physical discipline with their children in the first year after birth compared to non-depressed fathers (Davis et al., 2011) and to communicate with their infants in ways that are more self-focused and critical (Sethna et al., 2012). Paternal postnatal depression can also have a negative impact on child development outcomes. For instance, there is now fairly conclusive evidence that children of depressed fathers are substantially more likely to develop behavioural and emotional difficulties, including conduct disorders and hyperactivity (Ramchandani et al., 2013; Sweeney & MacBeth, 2016). Where is the help for fathers? Despite these advances in knowledge, new fathers experiencing depression remain less visible than depressed mothers, both within healthcare and societally. One important reason for this is gendered constructions of masculinity that emphasise male toughness, stoicism and self-reliance (Connell & Messerschmidt, 2005; Courtenay, 2000). In simple terms, men experiencing or vocalising symptoms of depression are perceived as transgressing normative expectations and expressions of hegemonic masculinity (Krumm et al., 2017). This has a dual impact on men’s mental health. First, for men themselves, particularly those who strive for hegemonically masculine ideals,

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the psychologist may 2019 postnatal depression in fathers

barrier to men’s help-seeking asking for help can be incredibly behaviours. For example, studies difficult precisely because it is Viren Swami is suggest that, when members transgressive. Instead, men are much in the School of of the public are presented more likely than women to deal with Psychology and with vignettes of mothers, the symptoms of depression through Sport Science, ability to correctly label cases self-help – drinking, aggression and Anglia Ruskin of postnatal depression is withdrawal are all common responses University, relatively high, at about 75–90 to symptoms of depression. Cambridge. per cent (Swami et al., in press; It would be easy to dismiss the viren.swami@anglia.ac.uk Thornsteinsson et al., 2014). impact of masculinities on helpBut when identical vignettes seeking behaviour in men. I am of mothers and fathers are presented, members of a case in point. I have written about the impact the public are much less likely to correctly identify of masculinities on men’s mental health in The postnatal depression in fathers (at about 45 per cent). Psychologist (Swami et al., 2008). I have conducted Instead, fathers showing symptoms of postnatal research that links masculinities to poor symptom depression were more likely to be described as recognition of depression in men (Swami, 2012). ‘stressed’ or ‘exhausted’ rather than depressed (Swami And yet, as I began to experience symptoms of et al., in press). In other words, lay individuals may depression following the birth of my son, I found it near impossible to ask for help. A part of this stemmed be less likely to see the difficulties faced by depressed fathers as issues of mental ill health and more likely from a difficulty admitting that I might be depressed, to emphasise factors that are common to most new particularly at a period when cultural and family parents, such as a lack of sleep. This gender binary expectations suggested that I should be happy. But might mean that fathers delay help-seeking, believing there was a great deal of shame, too – at my frailty, their symptoms to be manageable or because of a fear my uselessness as a father, my inability to ‘man up’ of being stigmatised for asking for help (Mickelson et and face the challenges of caring for my son. To be al., 2017). depressed after the birth of my son felt selfish, and I And to the extent that practitioners internalise felt shame at the burden I placed on my wife whenever these negative attitudes, it is likely to mean that I struggled to function, whenever I withdrew. And men are not given the space and that shame was debilitating: if I time to air their mental health struggled to ask my wife for help, concerns. In fact, there is very what chance was there of asking for “fathers who experience little clinical guidance for assessing help from practitioners who were greater difficulties with and supporting at-risk fathers strangers to me? childcare than they initially in the UK. For example, the But hegemonically masculine National Institute for Health Care ideals can also mean that expected show greater Excellence (NICE) continues to practitioners are less likely to symptoms of postnatal describe postnatal depression as recognise symptoms of depression depression” primarily maternal and highlights in new fathers or provide the importance of supporting the opportunities to raise concerns partner of a depressed mother, about men’s mental health but provides no guidance on how to identify paternal (Hammarlund et al., 2015). I recall trips to see health postnatal depression or how best to provide care for visitors and midwives who routinely asked my wife fathers. This means that symptoms of depression about her mental health after the birth of our son. I in new fathers often go undetected, forcing them to was never asked the same questions. I don’t mean to manage depressive symptoms on their own and leaving blame individual practitioners, but the invisibility of them feeling frustrated when they are unable to do my mental health concerns only forced me further so. The invisibility of my own depressive symptoms into a false stoicism. This is a common experience: to healthcare practitioners frequently forced me to new fathers often describe feeling overlooked when in contact with family-centred services following the birth question the legitimacy of depressive experiences and to avoid seeking help as a result, a common experience of a child (Darwin et al., 2017; Fägerskiöld, 2006). In the UK, for example, the tradition and culture of health for new fathers (Darwin et al., 2017). Thankfully, as scholarly recognition of paternal visiting is heavily focused on mothers and children, postnatal depression has emerged, practitioners are and there is a reluctance on the part of some health being challenged to reconsider how they relate to new visitors to address paternal postnatal depression. In fathers. For example, the group Fathers Reaching part, this is because of a lack of work time, relevant Out actively campaigns for better understanding of training and clear guidelines (Oldfield & Carr, 2017), fathers’ mental issues and similar national campaigns but it also stems from a perception that men are not have been run in the UK (McConnell et al., 2014). or cannot be at risk for depression after the birth of a Health visitors, who play a key role in helping families child (Whitelock, 2016). to meet their emotional and physical needs in the Societal norms and attitudes can also act as a

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Karin Creemers/www.karincreemers-illustrator.com

UK, and family-centred practitioners more generally, are now encouraged to pay closer attention to the mental health of new fathers, to seek appropriate education and training, and to more actively engage with fathers (Oldfield & Carr, 2017; Whitelock, 2016). This includes the provision of father-specific care during the antenatal period, when the anxiety and stress experienced by some fathers could be alleviated (Bergström et al., 2009; Tohota et al., 2012). Routine screening of new fathers for depression, so that all parents are treated equally, is now being placed on the agenda (Edward et al., 2014; Paulson & Bazemore, 2010). There is concern that current screening tools used for women may not be valid for use in new fathers (Massoudi et al., 2013), but their use alongside male-specific depressive measures, such as the Male Depression Risk Scale (Rice et al., 2013), may improve screening outcomes. Programmes to promote father-inclusive health services are also beginning to emerge (Price, 2018) and, in some Sure Start Children’s Centres in the UK, fathers are routinely encouraged to attend men’s groups, where added support can be provided, particularly for men who may be unwilling to disclose symptoms of mental health disorders in routine postnatal care (Coleman et al., 2016; Potter & Carpenter, 2010). Extending these programmes nationally is an important next step for practitioners. But these policy suggestions are unlikely to achieve longer-term success in the absence of broader societal challenges to constructions of fatherhood and masculinities. National and community-based educational programmes that raise awareness of, and challenge assumptions about, paternal postnatal depression are important to give new fathers the space and tools to confidently and proactively seek help when needed. Societal support, including adequate paid paternity leave (and ensuring that new fathers are supported to effectively use paternity allowances) is also important, particularly as it would give new fathers time to adjust to their new familial roles and feel more confident about managing employer expectations, family needs and the family’s economic situation (Feldman et al., 2004; Kowlessar et al., 2015). Providing and developing community-based support networks for new fathers, which focus on the active roles of fathers and helping to relieve a reliance on partners as primary support providers, can also help to alleviate stress in the postnatal period (Kim & Swain, 2007). Providing parents with access to psychoeducational programmes that promote realistic expectations of becoming a parent and the development of psychosocial tools to strengthen positive ties to one’s partner can be very helpful in the transition to parenthood and to prevent relationship dissolution (Daley-McCoy et al., 2015). Providing opportunities that facilitate dialogue between fathers, including fathers of older babies and toddlers, could be useful especially for new fathers that lack male connections (Kumar et al., 2018). Finally, for fathers

that are diagnosed with postnatal depression, ensuring adequate longer-term care is available and adequately funded is vital. My son The spiral of depressive episodes and symptoms is often incredibly debilitating for new fathers, and we need to be much better supported. In my case, it took repeated breakdowns and the support of my wife for me to finally approach my GP for help. I am now receiving excellent therapeutic care for my depression and am in a better place a year after the birth of my son. I still occasionally struggle and I still have a lot to learn about being a good parent, but I am on the path to getting better. Some might not like everything that I have said here, especially as my son will eventually be able to read all this. The truth is, it breaks me to know that my son will one day learn that his father was unable to cope with his arrival into the world. But I also believe that, if things are to change, we have a responsibility to be honest with our children. I never want my son to experience depression, never want him to go through what I have. But I also want him to know that if he ever does need help, both his parents will be there to support him. And I also want him to know that, in my darkest days, it was he that gave me the strength to keep fighting. In spite of the anxieties, the fear, the self-loathing, a love for my son deeper than anything I thought I’d ever know began to grow. And that love continues to evolve every day and is the reason I’m able to write this. When my son is old enough to read this, I hope he understands that I was never my depression. And that I will always love him.

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the psychologist may 2019 postnatal depression in fathers

UCL GREAT ORMOND STREET INSTITUTE OF CHILD HEALTH

Postgraduate Training in Paediatric Neuropsychology Applications are now open for the professional training programme in paediatric neuropsychology starting in September 2019 delivered by University College London and Great Ormond Street Hospital for Children.

The Masters/PG Diploma in Applied Paediatric Neuropsychology is open to all professional psychologists and psychology graduates. The Masters/PG Diploma in Clinical Paediatric Neuropsychology is open to Clinical Psychologists and Educational Psychologists.

Programme Directors: Professor Michelle de Haan & Dr Sara Shavel-Jessop

For further information please check: www.ucl.ac.uk/ich/education/taught-programmes/paediatric-neuropsychology www.ucl.ac.uk/centre-developmental-cognitive-neuroscience www.ucl.ac.uk/ich/research/developmental-neurosciences/cognitive-neuroscience-neuropsychiatry

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A message of hope and resilience Clare Jones and Alan Barrett on the development of the Manchester Resilience Hub in response to the May 2017 bombing.

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t 22.31 hours on 22 May 2017, an improvised explosive device was detonated in â&#x20AC;&#x2DC;The City Roomâ&#x20AC;&#x2122; Foyer area which links Manchester Arena to Victoria rail station. It was an attack on music fans and their families as they were exiting a music concert, but it quickly felt like more than that too. An attack on all that Greater Manchester represents, its cultural heritage and identity, at a time when more power was being devolved from Whitehall. Many of us working in mental health were saddened and angered by this attack and felt a strong desire to do something. An extraordinary event demanded an extraordinary response, and so with the inventiveness and ingenuity that Manchester is synonymous with, a specific approach was developed. As we near the second anniversary of the attack, we reflect on the work of the Manchester Resilience Hub (MRH), a new enhanced NHS service to support the mental health of those affected. The ďŹ rst days and weeks Within a few hours of the attack, senior staff from psychological therapy and other mental health services

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the psychologist may 2019 manchester resilience hub

across Greater Manchester (GM) made themselves known to Silver Command on hospital sites, and got on with offering support to frontline staff to enable them to continue their roles. Spaces were provided for people to decompress after a shift, with food, drink and a listening ear on hand. When requested by acute care colleagues, direct support to the injured and their relatives and friends was provided. Secondary schools were contacted by their local mental health service with an offer of advice and support. Infographics and media messages describing normal responses to trauma, and when and how to seek professional help, were written and disseminated. National charities are commissioned to provide the initial psychosocial response to such incidents, and the Red Cross, Victim Support and Foundation for Peace began providing immediate emotional and practical support to those affected. Four days after the attack, senior clinicians and managers from the four GM mental health providers sat around a table with colleagues from the Strategic Clinical Network to discuss next steps. Pathway documents were developed for Adults, and Children and Young People, which were shared within two weeks with colleagues in London following a number of significant incidents they suffered. With no funding available and potentially thousands of people affected, the Clinical Commissioning Groups agreed to underwrite an initiative for the first year in the hope of securing national monies. Drawing on other terrorist incident responses, a model was developed, ratified, operationalised and fully staffed and mobilised with seven weeks. This new NHS service, the ‘Manchester Resilience Hub’, was set up to support the mental health and emotional wellbeing of all those impacted. It was an innovative model with mental health clinicians from across GM from adult mental health and child and adolescent mental health services being seconded to form a team. The different organisations showed they could rise above the normal day-to-day differences and irritations, pulling together to create this new service, with many staff going above and beyond. The community response Attacks on the way of life of communities, such as the targeting of young people enjoying a music concert, often lead to an increase in that activity. Thus the community got behind the ‘We Love Manchester’ concert, within a fortnight of the attack. Of course this prompted anxiety amongst many parents/carers who saw their children going to a concert so soon after the traumatic events, but the people of Manchester were united in their defiance. This had been an attack on their city, on their heritage, their way of life: but it would not become the dominant narrative. The general public showed their solidarity with those directly affected. Hundreds attended the vigil in St Ann’s Square a week after the attack, there

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were queues around the block for bee tattoos (the Manchester symbol of industriousness, hard work and community spirit) and thousands of bee stickers appeared on cars and in shop windows. More than £21M was raised for the bereaved and injured via the We Love Manchester Emergency Fund. This outpouring of support and affection has been really important for the identity of the city and region. But we have to hold in mind that recovery can be a long-term process. After the 10,000 items left at memorial sites were archived and the city was returning to normal, families continued to live with the consequences of this horrific attack. Some of those directly affected, whilst feeling supported by the community response, found it difficult to reconcile the early path to recovery for the city with their own understandable continued difficulties. For families not living in Manchester there was the added complexity of having their recovery journey far from the location and community who had been targeted. The Manchester Resilience Hub Within days a dedicated NHS telephone helpline and email address was established, and staffed by the regional Military Veterans’ Service on a voluntary basis with the support of other volunteer clinicians. Initially available to professional staff, it quickly became the referral route for partner agencies to direct requests for support for the injured, bereaved, and those on the police witness list. Once the Hub was fully operational it began proactively reaching out to all online ticket purchasers for the concert. People were invited to complete online screening questionnaires on trauma, anxiety, low mood and functioning, via a customised web portal. This has been repeated at three monthly intervals for the first year, and then six monthly intervals. We work hard to provide equitable access to support by using telephone or email contact. On the phone we typically undertake clinical triage and psychoeducational support. For those who need it, we facilitate local evidence-based psychological and mental health treatment services. By the end of year one, 3281 individuals were ‘open’ to the Hub, able to access support when needed. There is no symptom threshold or exclusion criteria. We know that the journey to recovery can be changeable, so our service users are able to access us when it suits them, and we can check in with them as clinically appropriate. It’s a psychologicallydriven, community model. Building relationships with families allows us to check in with them regularly; strengthening families’ day-to-day support structures is crucial. Promoting psychological health As Lord Kerslake’s report into the incident said, ‘The journey to recovery after psychological trauma varies and those affected need flexible offers of support’.

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Towards the first anniversary the Hub began to provide additional support to our service users. The Hub facilitated supported return visits to the Arena. There were also ‘virtual visits’, using immersive 360 degree virtual reality headsets. Home visits supported families to formulate their difficulties and make care plans. Parents and carers described the anxieties they had supporting their child. Greater Manchester Police, who were holding briefings to witnesses on the criminal investigations, were hearing the same. Together, we developed, organised and delivered a one day workshop on overcoming trauma for families: a safe environment for children and young people to meet, share their experiences and learn more about reactions to single incidence trauma. The combination of psychoeducation and space to reflect on personal experience and issues, facilitated by clinically qualified staff, gave us the best possible chance of going beyond support to real therapeutic shift. The feedback was so positive, and charitable donations allowed us to plan more workshops. 80 per cent of those open to the Hub were not from GM, so delivering workshops around the UK was important. During the second year of the Hub we have taken our staff, GMP and our colleagues in VCSE to Scotland and the North of England, delivering workshops on overcoming trauma to families, young people and adults. In addition to supporting individuals – both concert goers and those affected in a work capacity – we have also provided psychologically informed advice and consultation to other organisations. This attack was also unprecedented from a Local Authority and Police perspective, so we worked closely with them. We advised the We Love Manchester Emergency Fund so they could get to a position where they made financial gifts to those psychologically injured, as well as the bereaved families and physically injured. It’s the first time a fund has made gifts like this. The first anniversary required detailed planning by the local authority, and again the MRH was able to contribute by bringing a clinical perspective to this emotive and important occasion. We provided direct support to families before, during, and following the event at Manchester Cathedral. This included a discreet support function within the venue, arranging advertising of support services throughout Manchester and assisting with protecting families from any media intrusion. Hub staff Clare Jones is a Consultant also remained in contact with many Clinical Psychologist and Clinical other families who had chosen to Lead for Children and Young stay away from the official marking People. clare.jones14@nhs.net of the anniversary, and offered follow up support to all. Alan Barrett is a Consultant Clinical Psychologist and Clinical Lead, and Honorary Professor at the University of Salford. alanbarrett@nhs.net 36

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New technologies allowed people to experience a virtual return to the Manchester Arena through use of a 360 degree video headset

Next steps Manchester suffered a deadly terrorist attack on children, young people and their families out enjoying themselves at a concert. It demanded that services stepped up to try and do the right thing. We feel it has been of value, and families tell us they welcome us reaching out to support them. More formal evaluation is underway. The MRH is now actively contributing to the local Emergency Preparedness and Resilience and Response (EPRR) planning, as well as at a national and international level. As we move into the third year we continue to offer screening at regular intervals, allowing families to track their progress as they continue their recovery journey. There are particular groups, such as professionals, who we persist in assertively reaching out to. And we remain aware that individual needs and wants vary: we continue to learn and develop, to meet the changing psychological needs of those affected. Find out more www.penninecare.nhs.uk/your-services/ manchester-resilience-hub

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the psychologist may 2019 manchester resilience hub

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How do we ‘other’? Peter Hegarty on asymmetries of reasoning for lay and professional psychologists alike

Psychological research and practice can enhance or reduce social fairness, and it often does both. This article examines how and why researchers inadvertently reproduce social inequalities when certain habits of thought affect our framing of our research findings.

n 2016 Tamika Cross, a young AfricanAmerican woman, was a passenger on a flight across the USA when cabin crew asked if any doctor on board could help in an unexpected medical emergency. When Dr Cross came forward, she was initially prevented from helping the ill passenger; the cabin crew took some time to be convinced that she was indeed a doctor. When a white doctor next presented himself, Cross was reportedly told, ‘Thanks for your help, but he can help us.’ Cross’s experience could have been particular, but the viral response to it from other young AfricanAmerican professional women suggests that it is not. Category norms for professions may fold in not only information about gender, but also race, and their intersections (Cole, 2009). And they can be a matter of life-and-death. Of course, this was a real-life version of the now famous surgeon riddle: A man and his son were away for a trip. They were driving along the highway when they had a terrible accident. The man was killed outright but the son was alive, although badly injured. The son was rushed to the hospital and was to have an emergency operation. On entering the operating theatre, the surgeon looked at the boy, and said, ‘I can’t do this operation. This boy is my son.’

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In their 2006 study, David Reynolds, Alan Garnham and Jane Oakhill found that about half of people who have not seen this riddle before failed to find the correct answer that the surgeon was the boy’s mother. Surely everyone these days knows that some surgeons are women, so why do they find the riddle difficult? Because the noun surgeon automatically calls to mind imagery of a man. Such thinking is automatic, in the sense of happening beyond conscious awareness, intent and control. In their 1986 account of ‘norm theory’, Daniel Kahneman and Dale Miller argued that automatically activated working memory representations of categories can render implicit the most prototypical features of the exemplars that ground those category representation (such as the gender of surgeons). People cannot always access the assumption they have made which is limiting their thinking. Such non-conscious knowledge activation can

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the psychologist may 2019 how do we ‘other’? www.nickoliverillustration.com

have such surprising effects on conscious thinking, including the kind of reasoning that psychological scientists do. Recently, inspired by Wason’s (1960) classic experiment on the formation and test of hypotheses, I constructed a ‘celebrity guessing game’, taking the example of the assumed whiteness of film stars as a case in point. Students first saw the names of three film stars and were told that they shared a common attribute that the experimenter held in mind. On each turn of the guessing game, each participant wrote down a hypothesis about what that attribute might be, and generated the name of one new celebrity. The experimenter revealed whether the hypothesis had correctly guessed the true attribute and whether each new celebrity possessed or lacked the attribute on each turn of the game. When the film stars that I provided were black and the attributed-to-be-guessed was race, 90 per cent of participants correctly guessed it, taking about six to seven minutes to win the game. When the film stars were white, a majority of both white and non-white participants failed to discover that all three actors shared a race within the allotted 20-minute period (Hegarty, 2017). As with the gender of surgeons, the race of white film stars was automatically assumed by category norms for such categories as ‘actors,’ ‘Hollywood stars’ or ‘people who go to the Oscars’. The assumption was automatic, but its effects on subsequent conscious reasoning were large.

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‘High-status’ identities It is no coincidence that these two attributes folded into category norms that I have discussed so far – being a man and being white – are higher-status identities. Several intellectual traditions of oppressed people have analysed in rich depth how higher-status groups, such as the middle classes (Marx & Engels, 1978), men (de Beauvoir, 1949/2011), white people (DuBois, 1903), or heterosexuals (Warner, 1993) achieve and sustain social power by successfully conflating their interests and perspectives with the universal, impartial or objective definitions. As professional psychologists, we are not immune to conflating higher-status groups with the norm, and of unthinkingly reinforcing status hierarchies. In the celebrity guessing game studies, participants were more likely to alight on the hypothesis that the three white film stars shared the attribute of ‘race,’ if they had first generated the name of a non-white celebrity and received feedback that this celebrity did not fit the experimenter’s rule. Such thinking would lead a body of researchers to collectively conceptualise race as primarily a characteristic of BAME individuals and only secondarily of white people. The psychological literature bears the imprint of such thinking. Psychological research articles with the terms culture, race or ethnicity in their title, abstract or keywords have a higher proportion of minorities,

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and fewer whites, in their samples than does comparable research that does not reference culture, race or ethnicity. Irrespective of their own ethnic selfidentification, American psychologists rate an all-white sample more positively for a proposed study addressing personality, but an all-minority sample more positively for a proposed study addressing culture. Psychologists also believe that their fellow researchers would consider the relative importance of personality and cognitive factors to be more explanatory for whites but social and cultural factors more explanatory for ethnic minorities (Causadias et al., 2018). This cultural mis-attribution bias might particularly sustain inequality because it leads psychologists to conceptualise whites as individuals and ethnic minority individuals through the lens of group stereotypes (Fiske & Neuberg, 1990). There is nothing in our arsenal of tools for establishing reliability or validity that requires us to stand outside of this logic.

The ‘effect to be explained’ The celebrity guessing game and the cultural misattribution bias refer to contexts where psychologists have Key sources sampled from only one group on a status hierarchy. However, when differences between groups that Causadias, J M., Vitriol, J.A. & Atkin, differ in status must be explained, A.L. (2018). Do we overemphasize the the imprint of category norms role of culture in the behavior of racial/ ethnic minorities? Evidence of a cultural appears once again. In studies (mis)attribution bias in American in which students are asked to psychology. American Psychologist, 73, generate explanations for empirical 243–255. group difference using their own Fasoli, F., Maass, A., Paladino, terms, they write explanations that M.P. & Sulpizio, S. (2017). Gay- and spontaneously position the higherlesbian-sounding auditory cues elicit stereotyping and discrimination. status group as the reference group Archives of Sexual Behavior, 46, for comparison and the lower-status 1261–1277. group as the ‘effect to be explained’. Hegarty, P. (2017). On the failure to For example, explanations of gender notice that white people are white: differences in voting preferences Generating and testing hypotheses in would more often reference the the celebrity guessing game. Journal of Experimental Psychology: General, 146, claim that ‘women are more liberal’ 41–62. than the claim that ‘men are more Hegarty, P. & Bruckmüller, S. (2013). conservative’ (Hegarty, 2006; Miller Asymmetric explanations of group et al., 1991). differences: Experimental evidence of Similarly, about three quarters of Foucault’s disciplinary power. Social the content of explanations of ‘race’ and Personality Psychology Compass, 7, 176–186. differences and sexual orientation Lundberg, T., Hegarty, P., & Roen, K. differences reference how and why (2018). Making sense of ‘Intersex’ and lower-status groups are different ‘DSD’: How laypeople with varying from higher-status groups’ whilst experience of intersex/DSD understand only one quarter of it references and use terminology. Psychology & how higher-status groups are Sexuality, 9, 161–173. Miller, D.T., Taylor, B. & Buck, M.L. different from lower-status groups (1991). Gender gaps: Who needs to be (see Pratto et al., 2008, on ‘race’; explained? Journal of Personality and and Hegarty & Pratto, 2001, 2004, Social Psychology, 61, 5–12. on sexual orientation). Across these studies, participants explained Full list available in online/app version. gender, race or sexual orientation

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differences in matters as diverse as group differences in voting behaviour, sickness rates, trust in the police, recall of childhood play experiences, responses to medication, drug rehabilitation and charitable donations. These studies were conducted largely on students, themselves an unexamined ‘normative’ group in psychology research for almost a century (Danziger, 1990). However, published psychological research also attributes empirical gender differences to women and girls more than to men and boys (Hegarty & Buechel, 2006), and some researchers have attributed the development of sexual orientation to homosexual and bisexual groups only, whilst being explicitly aware that such patterns of reasoning constitute a heterosexist bias (see Hegarty & Pratto, 2001, p.732, for evidence; and Herek et al., 1991, on heterosexist research bias). Such thinking, framing explanation as being disproportionately about lower-status groups, would be an embarrassment to our efforts to keep our science free of social biases on its own. But it can also communicate that lower-status groups are less agentic, less powerful, less worthy, and have a less legitimate claim on power than higher-status groups. The ‘thing’ in the referent position is framed as larger, more important and more immovable than the thing that is figured against it (Gleitman et al., 1996). For example, gender differences in leadership are seen as smaller and less legitimate when women leaders are described as different from men leaders than when men leaders are described as different from women leaders (Bruckmüller, et al., 2012). And some groups – such as left-handers and single people – feel worse about their group identities, showing lowered collective selfesteem (Luhtanen & Crocker, 1992) when they write about how their group differs from its higher-status complement (i.e. right-handers and coupled people) than when asked to write about how such high-status groups differ from their own (Bruckmüller, 2013). The linguistic framing of explanations, then, not only projects implicit beliefs about group status, it also communicates a set of related beliefs. Power is ‘done’ not ‘possessed’ These findings pertain to social identity, but this isn’t simply an expression of the basic motive to enhance one’s self-esteem by positioning one’s own group in a good light relative to others. If that were the case, why would women and men, to an equal extent, attribute gender differences to attributes of women rather men (Hegarty, 2006; Hegarty & Buechel, 2006; Miller et al., 1991), or both minority psychologists and white psychologists show the cultural misattribution bias (Causadias et al., 2018). This means that attempts to diversify our samples, or our profession, will not, on their own, simply undo these habits of thinking. We’re dealing with a discursive form of power; we need to think of power as something that is done rather than possessed (see also Simon & Oakes,

08/04/2019 11:56

the psychologist may 2019 how do we ‘other’?

2006). In Foucault’s (1978) terms, psychological science relations of power-knowledge are not static forms of distribution, they are and the British, nor differences ‘matrices of transformation’. between the Welsh and the English, To install the reverse matrix, are consistently explained by psychologists might read cultural taking the Irish or the Welsh as the psychologist Glenn Adams (2014) ‘effect to be explained’ (Donnelly on ‘resource extraction’ models of Peter Hegarty is Professor & Hegarty, 2018; Hegarty, 2013). psychological research, observing of Social Psychology at the Despite expectations, the usual group differences but failing to University of Surrey where he asymmetry in explanations was address the normative status of leads the research group on not observed in this context. economies of excess and selfSocial Emotions and Equality Experiments can (usefully) prove expansion. We need to take a in Relations our hypotheses to be wrong. ‘denaturalising’ turn. Take auditory p.hegarty@surrey.ac.uk Recently, Eitan et al. (2018) gaydar: the attempt to detect others’ extended this line of thinking about sexual identities from vocal cues ‘the effect to be explained’ to political orientation. is one kind of ‘gaydar’ judgement that has fascinated These authors presented participants recruited online some psychologists for two decades (Rule & Alaei, via social media sites with social psychological 2016). Gaydar research has recently been critiqued conference abstracts presented at the meetings of the for the essentialist assumptions about sexuality that Society for Personality and Social Psychology over are re-grounded by its emphasis on finding detectable a 10-year period. The abstracts focused on political biologically rooted group differences, particularly topics, and participants evaluated whether the focus differences between gay and straight men (Miller, of explanation in these articles was skewed toward 2018; Vasilovsky, 2018). Recently, I have worked with political conservatives or political liberals (56 per Fabio Fasoli and others to begin to reconceptualise cent vs. 42 per cent of all articles). Interestingly, auditory gaydar from targets’ perspectives. We asked liberal online participants were more likely than their heterosexual-identified and sexual minority women conservative counterparts to judge the articles as and men whose voices were being recorded for use focusing on conservatives. A group of mostly liberal in auditory gaydar studies to report whether they social scientists correctly predicted the direction of this believed that their own voice communicated their effect but overestimated its magnitude. sexual identity, and whether they desired that it would. That study shows only weak evidence of, as the Men considered that their voices communicate sexual authors put it, a ‘liberal bias’. Yet they make a strong orientation more than women did, and straight claim that their report evidences ‘systematic effects of men desired that their voices would communicate political values on research reports in a scientific field’. their sexual orientation more than did any of the I find myself thinking back to that research on race and other three groups. Such research findings require a sexuality. If asked to explain a difference in liberals’ consideration of social status, a matter that is rarely given sustained attention in studies of gaydar accuracy. and conservatives’ responses to a blood pressure For gay men, being a target of gaydar risks heterosexist medication (see Pratto et al., 2008) or a treatment for cancer (see Hegarty & Pratto, 2001), would study discrimination (see Fasoli et al., 2017). For straight participants focus explanations on conservatives more men – the higher-status group – such recognition than on liberals by a ratio of 3:1 – like participants engenders no such risks. focused their explanations on African-Americans and gay men in these earlier studies? Would both liberal and conservative people quickly spot that three Limit conditions conservative celebrities share politics as an attribute There are good reasons for social psychologists to but overlook the fact that three liberal celebrities do, quantify the distorting effects of category norms on mirroring the celebrity guessing game? our thinking about difference. The claim that one’s I have been slow to call the effects I have found group has been positioned as ‘the other’ unfairly by in my experiments ‘bias’, a term that may have an psychological research can contribute to discourses essentially pejorative meaning; I have more often of competitive victimhood by which groups engaged in described category norms as creating asymmetries in conflict seek to frame themselves as the victim in a reasoning. However, I would argue that there’s more current conflict and mutually fuel conflict escalation evidence of a ‘white bias,’ ‘male bias’ or ‘heterosexual (Noor et al., 2012). Consequently, it is important bias’ in psychology than the ‘liberal bias’ that many to consider the limit conditions of the relationship have discussed in recent years. I hope this article between status and the framing of explanations allows psychologists who wish to undo bias in our field described here. Nationality appears to be one such in conscious ways to understand a habit that works limit. In spite of hierarchies of size and power between against our intentions. these countries neither differences between the Irish

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08/04/2019 11:56

2019 CPD workshops Professional development opportunities from your learned Society We are pleased to launch our popular core programme and some of our workshops for 2019. How to develop and evaluate digital behaviour change interventions

29 April

Supervision skills: Workshop 3 – Models of supervision

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Organisational compassion

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Attachment in practice: Part 1 – Attachment theory, past and present controversy and understanding

8 July

Attachment in practice: Part 2 – Attachment, what is best practice in respect of the assessment and treatment

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Aviation psychology: Clinical skills for working with air crew

18–19 July

The role of the psychologist in responding to youth suicide in schools

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Supervision skills: Workshop 2 – Enhancing supervision skills

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Supervision skills: Workshop 4 – Ongoing develeopment: Supervision of supervision

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Expert witness: Workshop 1 – Roles, responsibilities and business

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Expert witness: Workshop 2 – Writing the expert witness report for court

13 September

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For more information on Supervision skills and Expert witness training and dates visit: www.bps.org.uk/find-cpd You can book on all workshops here: www.bps.org.uk/events

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05/04/2019 14:09

researchdigest_Layout 1 01/12/2016 16:36 Page 1

Research. Digested. Free.

Now including PODCAST and APP

www.bps.org.uk/digest ‘Easy to access and free, and a mine of useful information for my work: what more could I want? I only wish I’d found this years ago!’ Dr Jennifer Wild, Consultant Clinical Psychologist & Senior Lecturer, Institute of Psychiatry ‘The selection of papers suits my eclectic mind perfectly, and the quality and clarity of the synopses is uniformly excellent.’ Professor Guy Claxton, University of Bristol

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05/04/2019 14:09

Resources for hope in the distressed city Mark H. Burton

Distress in the City: Racism, fundamentalism and a democratic education Linden West Trentham Books £24.99

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ver more than a hundred years, industrial capitalism created urban landscapes that brought people together in huge numbers, ordering their diverse lives through the discipline of the factory yet providing the basis for a resilient social fabric forged in struggle. And then it decamped to exploit cheaper reserves of labour power. Despite its endless self expansion, capitalism from time to time destroys some of what it has accumulated, discarding those whose lives have been structured through its processes of production and reproduction. This is the history of now post-industrial cities and towns, places like Bolton and Wigan, or that agglomeration of towns, Stoke on Trent or The Potteries. West’s book on Stoke is an ambitious attempt to connect diverse themes including post-industrial personal and collective distress, racist reaction and religious fundamentalism, the crisis of representative democracy and the commodification of education. He does this through what he calls auto/biographical narrative research, with interviews, observation, literary and documentary analysis, tied together with reflection and questioning in which his own positioning, as a

working class boy from Stoke, now a University academic, is explicit. West ties these threads together very well. A key theme is the disrespect experienced by people, both the white working class and ethnic and religious minorities. The system disrespects them and they can disrespect one another in turn; exemplified, for example, in the day-to-day experience by Asian taxi-drivers, of racist and Islamophobic abuse. West contrasts this with a non-idealised exploration of the tradition of working class self-education. Workers’ eduction recognised people with the right to be heard and to fully participate, respected as fully mature people with lives to relate and ideas to contribute. Being recognised went with recognising others, and with making a civic contribution. West draws on Raymond Williams, a scholar with similar origins. ‘Resources of Hope’, the title of a collection of some of his articles, is also one of his key concepts. West finds Resources of Hope in the tenuous revival of self-education and in the recovery of collective historical memory, for example in the revival of ‘Lidice Shall Live, an international solidarity action by Potteries

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the psychologist may 2019 books

A radical rethink

miners following the erasure of the Czech town and the mass murder of its population in a Nazi reprisal. A key message is the importance of making the effort to understand those with different life experiences and perspectives, even when this is very uncomfortable. A Stoke mosque did it, inviting English Defence League demonstrators in for tea, as described in one of the book’s more striking passages. For me, the book made connections among a number of my favourite themes: the state of postindustrial settlements, the recognition of ‘the other’, historical memory, community building, working class movement history and the ‘meta-psychology’ of Raymond Williams. I would have liked less on the theory of the investigation and more on its content and output, with more explicit model building for an engaged, psychologically informed socio-political practice. But for anyone concerned with ‘postindustrial distress’, it’s well worth reading. Reviewed by Mark H. Burton, Independent Scholar Activist

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The historically dominant view in Psychology has been that sensory input leads to motor outputs, strings of which amount to behaviour, and all is predicated upon neuronal functioning. As Hebb noted, behaviour is not quite under full environmental control, and something must happen inbetween to account for this. The middle term became the quest and since the 1970s models relying on mental representations have dominated. The basic idea was that for an organism to act on the world it must have an internal model of that world, something that coordinates inputs and produces relevant outputs. Representational models put all the causally relevant data into the representation, privileging the internal economy of the mind. But exploration and sharing of results. what if the outside world was a The greatest tool to emerge was sufficient model of itself from which symbolic language, which Ellis organisms simply needed to sample clearly sees a cultural product bolted data in order to produce statistically on to our dexterity, perhaps initially patterned responses? It is this through manual signing, but then idea that is at the heart of radical sophisticated vocal control. Whilst enactivist or embodied cognition Ellis does not quite state it, approaches, and Ellis lays it is clear that for him it was out the evidence for this an error for the discipline position eloquently and Bodies to internalise the external elegantly in this new book. and Other properties of tool-use and Ellis argues that we are Objects: The symbolic language: they sensorimotor creatures that Sensorimotor actively explore the world, Foundations of were delivering human agency from without just dynamically entraining Cognition fine. our nervous systems Rob Ellis This book will to deliver appropriate Cambridge motor behaviour, where University Press challenge cherished philosophical positions. appropriate is cashed out as £85 Not just commitment to immediate task demand but representational cognition, also with a teleonomic eye to an umwelt. At its ethical root this is but also prior conceptions of agency. As you read it you will begin to realise pure Hebbian neurophysiology. Toolthat perhaps the greatest challenge use is a key feature of the thesis, with tool-space extended beyond the initial to our discipline is not the replication crisis, but instead a collective failure biological design of Homo sapiens, to inspect our core theoretical but as a result of developments in assumptions. manual dexterity and its control. As a highly social species, tool-use soon Reviewed by Tom Dickins, Professor became a social practice enabling of Behavioural Science at Middlesex complex problems in tool-space to University be solved essentially through mass

08/04/2019 16:02

Powering Up Children: The Learning Power Approach to Primary Teaching Guy Claxton & Becky Carlzon Crown House Publishing £16.99

Our psychiatric future: The politics of mental health Nikolas Rose Polity Press £17.99

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Useful and useable Powering Up Children represents the latest addition to Claxton’s highly successful Learning Power Approach, a set of strategies and metacognitive skills that aim to empower learners to become more confident and independent. The emphasis is on learning to learn through building persistence, approaching mistakes constructively and collaborating with others. It’s a broad view of learning, rather than being shackled to the growing trend in education that emphasises memorisation and testtaking. Indeed, Claxton and Carlzon are eager to emphasise all that is wrong with the current education system and the obsession with exams. Powering Up Children shows how the Learning Power Approach has evolved over the past few years and it’s good to see that it has developed into a useful and useable set of strategies. Real-world examples of how to deploy the strategies and techniques add a practical element and case studies are used effectively. There are numerous ideas that can

be taken straight into the classroom with very little additional work for the busy teacher. The emphasis is on challenge as a transformative process and I particularly like the view of the learning pit, where challenge occurs at the bottom and children have to think about how they are going to climb out, allowing them to think a little more deeply about their own learning. Those familiar with Carol Dweck’s ideas around growth mindset and the grit model developed by Angela Duckworth will feel at home with Powering Up Children; for example, the section on using praise to challenge children and the use of ‘yet’ to build the belief that learning is challenging and takes time is reminiscent of Dweck’s own ideas. There are a few ideas that may well cause some teachers to wince, for example, the way the authors promote a shift from teacher to learning coach or the use of motivational quotes. The suggestion that children decide their own success criteria could also prove

problematic. But these are minor quibbles and by no means detract from the many great ideas included in the book. Powering Up Children is an excellent resource for primary school teachers with many of the techniques easily adaptable to work with children in the early secondary school years as well. Reviewed by Marc Smith, chartered psychologist, teacher and author

A blind spot for psychology? Nikolas Rose’s writings on the politics of health have been stimulating and influential. The title of this book is intriguing. Rose believes that ‘another psychiatry … is possible’ if it can turn itself into what he calls ‘social medicine’ (p.21). In other words, he believes that psychiatry can be saved from itself, even suggesting it should demedicalise distress (p.191). The academic style is irreproachable – even-handed, meticulously researched, offering a wealth of historical detail explaining how psychiatry has got to where it is today. Consequently, it reads rather like a series of reviews, certainly of great value to students. Initially, it is not clear that Rose wants to move outside a medical framework or question the concept of mental health. The focus is on psychiatry, including, for instance, arguments put forward to support each version of the DSM from 1 to 5. The neoliberal critique of psychiatry is analysed, as well as the concept of social capital, although he comes to no firm conclusion about either. He imagines psychiatrists giving up diagnosis and formulating people’s individual life circumstances. So what is the message? In essence, mental health is not just about brain disorders,

psychopharmacology is flawed, Western psychiatry will not solve global mental health problems, and service users’ own store of knowledge should be recognised. If you do not already agree with this position, Rose’s book is for you. It is only in the final chapter that he proposes ways in which psychiatry could be reformed. It should adopt a biopsychosocial model, with an emphasis on the social determinants of distress, and endorse political and social policies to back this up. He feels that any radical suggestion to abolish psychiatry is ‘sadly simplistic’ (p. 174). (Sadness in an academic is usually a sign of superior wisdom). Nevertheless, he would like people to be helped outside the formal mental health system and social adversity should be addressed directly. Formulation should replace diagnosis and psychiatry should contest the ‘narrative of disease’. The chance of this coming about? Zilch, in my opinion. Remarkably, Rose does not discuss non-medical approaches to mental health (apart from the role of service users), or any psychological theory whatsoever, nor mention that applied psychologists have been working on methods of formulation for the past 60 years. (But then sociologists have always had a blind spot for psychology). Reviewed by Richard Hallam, Independent researcher

08/04/2019 16:02

the psychologist may 2019 books

The oceanic feeling Ewan Morrison

vitality, hope, love (the obverse being that if I didn’t learn, this I have spent most of my adult life navigating through a minefield energy blockage could destroy me). I’ve laughed in the faces of of mental health issues – through misdiagnosis and conflicting Art therapists, and told them that the only people who ever get types of treatment, towards something resembling mental cured by art therapy are amateurs; that for serious artists, art is health in the last six years. I am now 50. This minefield is more like a drug than a cure. well known to many cultural outsiders and artists, and with a There is so much false mythology around the artist and misdiagnosis and the wrong kind of treatment the outcomes can mental health – a legacy we inherited from the 1960s. I know be tragic. from experience that it is only mild depression that leads to Whether or not it is true that creative people are 25 per cent the creation of paintings and poems; that deep depression is a more likely to carry genes for mental illness, we, as a culture, creatively barren place. I also know do love our ‘mad artists’. We love our that no-one can be creative on antiPlaths and Van Goghs, our Kurt Cobains depressants. Most artists who kill and David Foster Wallaces, our Chester themselves do so because they have Benningtons, Anne Sextons, Virginia become addicted to art as their only Woolfs. All those brilliant artists who source of self-worth and escape. battled depression, bipolar disorder, When they sense they will never be personality disorder; who lost the fight able to be creative again, external with the creativity that had sustained reality hits them, unmediated… it is them and who chose suicide, only to too much to bear. be romanticised once again for that Depending upon art can be very choice. In the end their creative energy dangerous. Like drug use, it isolates, either dried up or it wasn’t enough to it can lead you to a place where justify their suffering. Half of the artistic fear and resentment of the outside role models of my youth have killed world festers and grows. I’ve seen themselves and I have lost two friends and experienced addiction, and over who were artists to suicide. I have the years I’ve asked myself whether survived periods of suicidal ideation. obsessively making art is making me Since adolescence I sensed that well, or making me worse? Is art like I’d turned into something that wasn’t some demon of addiction, that wants like normal people. I also learned that to keep me dependent, keeping me ill? making art – writing fiction being my So how can a balance be struck chosen art – was the only way to feel between creativity as a healthy activity whole and not worthless. Making art – and the dangers of addiction to cured me of a stammer, it gave me selfcreativity-as-salvation that results, esteem, focus and escape from a broken so often, in mental collapse and the family and a hostile community. Alone danger of suicide? Over 15 years of with art, it gave me the ‘oceanic feeling’ creative writing and therapy I’ve come described by Jung, which is a high like Ewan Morrison’s novel Nina X – about a woman to certain conclusions. There are that of an opioid. Making art fed me vast who was born and raised in a cult – is published two different kinds of creativity – the amounts of energy. on 4 April by Little Brown. dangerous kind that is a secondary I recall one Psychodynamic gain of a disturbed mind; that is an addiction. And the gentler Psychotherapist telling me, ‘you have many conflicting kind of creativity that can heal a damaged person. personalities… if you didn’t have your writing you’d be lost.’ There are few therapists and psychologists I’ve encountered I recall another therapist (CBT with the NHS) telling me that I who understand this distinction. To my knowledge, after going might want to consider putting all the artistic struggle behind through five different types of therapy, no single one has it right me and looking for a gentler, more stable, kind of work. Then when it comes to artists. I remain fascinated by the process of there was the Jungian analyst who told me that my problems art-dependence, as someone who has been both addicted to art, with severe depression arose from a blockage of my artistic and saved by it. energy, and that if I learned to use that flow of I could be full of

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08/04/2019 16:02

‘By speaking I can help people realise they are not alone’ We speak to Dame Kelly Holmes and Dr Crepaz-Keay about a new audio series, What Do I Do? Mental Health and Me

aving experienced her own difficulties with depression and self-harm, in What Do I Do? Mental Health and Me, Dame Kelly Holmes sets out to discover how other people cope, talking to TV personalities, writers, comedians, journalists and more about their mental health. Kelly’s guests include: TV presenter Davina McCall; journalists Jon Ronson and Alastair Campbell; author Philip Pullman; comedians Catherine Bohart, Eddie Izzard, Felicity Ward and Rory Bremner; transgender rights activist Munroe Bergdorf; musician Amanda Palmer; and mental health experts Dr David CrepazKeay (Head of Empowerment and Social Inclusion at the Mental Health Foundation) and Owen O’Kane.

Dr Crepaz-Keay

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Why now? Dame Kelly Holmes: I am passionate about raising the awareness of mental health issues, but also stopping the stigma that has surrounded us for decades. People fear Dame Kelly Holmes with Eddie Izzard speaking out because of being judged. What are your hopes for the series? I first came out with my own Dame Kelly Holmes: That it will be interesting, struggles of depression and selfeye-opening, informative, funny, honest and real. harming in 2005. What’s happening to people now is not new, it’s just Dr Crepaz-Keay: Once heard, many will be able to people are listening. I also believe identify with the stories people tell and I would like this people in the public eye have a to lead to increased understanding of a range of mental voice and by speaking I can help health issues; how common they are; how anyone can be people realise they are not alone. affected by them; and how we can all respond positively to Dr Crepaz-Keay: Improving people’s mental health difficulties when and where they occur. I would also hope that the series will challenge understanding of mental health, some of the myths and stereotypes that still surround, mental ill-health and what we and sometimes taint, our understanding of mental can all do to help ourselves and health and, in particular, mental ill-health. In short, each other is becoming much I would like the series to have as large an audience more visible. Increasingly referred as possible and for all of these listeners to feel better to as Mental Health Literacy, it informed and more able to talk about and manage the forms an important part of the subjects addressed. public mental health and mental health promotion field. In order to How did you include expert input? ensure that this knowledge and Dame Kelly Holmes: I sat with Dr Crepaz-Keay to discuss understanding reaches as many all the topics that were raised during my interviews, people as possible, I would like to see everybody talking about mental so we could talk about how those listening could help themselves if needed. health.

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the psychologist may 2019 culture Dr Crepaz-Keay: As someone who, like Dame Kelly Holmes and all the other contributors, has personal experience of living with a psychiatric diagnosis and all that goes with it, I felt privileged to be part of such an exciting project. My primary role was to explore what is known about the conditions and experiences raised by the contributors. This would include how common the conditions are; what we know about the causes; the impact they are likely to have on people’s lives, and sometimes the lives of those around them; what treatments might be offered and what people can do to help themselves or their families or friends, if they are affected. As well as drawing on my personal experience and all that I have learned from my work at the Mental Health Foundation, I have spent a good part of the last year working with Public Health England on their national public mental health campaign. This has helped me bring a strong evidence-based approach to translating often clinical knowledge into the public mental health environment. I think it is vital that everyone understands much more about their own mental health and what they can do to support it regardless of any concerns around mental ill-health. What were the challenges in putting the series together? Dame Kelly Holmes: Only locations and juggling diaries. I went to all my guests’ chosen location to record the shows. Which guests surprised you most and why? Dame Kelly Holmes: Wow, that’s a hard question, because I went in blind just wanting to know their stories. I think Rory Bremner and confidence issues on stage surprised me. I didn’t realise how bad it had been for Davina McCall and her alcoholism or Alistair Campbell and his psychosis… sitting on his toilet in his bathroom while he was playing the bagpipes was rather interesting! Eddie Izzard was just astonishingly bright! Sitting at a church overlooking Cardiff was surreal in many ways. What would you like to see more of from psychology / psychologists? Dr Crepaz-Keay: For many years mental health has been understood as shorthand for mental illness; psychologists play a vital role in helping people to understand that mental health is something we all have, regardless of the presence or absence of mental ill-health. As the series clearly demonstrates, psychologists have offered many people a great deal of support to help them deal with a whole range of challenges. But I think their most important role is giving people the skills and confidence to manage their own lives, overcome adversity and fulfil their potential. The audiobook is available from Audible via tinyurl.com/y35udrw3

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Uncanny and unsettling Following the enormous success suits and wielding sharp scissors. of his 2017 film Get Out, for which They are physically the Wilson’s he won an Oscar for Best Original doppelgängers, but emotionally Screenplay, Jordan Peele is back in and intellectually: that’s another the cinema with Us. For both films question. Peele is an auteur (writing, producing The film doesn’t dwell on and directing), but he leaves the the psychology of meeting one’s acting to others. Lupita Nyong’o doppelgänger, although that’s heads up the cast as Adelaide Wilson, understandable when they’re and Winston Duke (last seen rushing at you with in Black Panther) is her sharp implements. The ﬁlm husband Gabe. With their doppelgängers are of a more Us kids Zora and Jason, they’re a allegorical nature. Peele is Dir: Jordan picture-perfect, all-American interested in the symbiotic Peele family. relationship between the The film starts some ‘haves’ and ‘have nots’ in thirty years earlier, with a rampant capitalism, be it stunning scene set in 1986. The in America’s slave past or gadgetyoung Adelaide (Madelaine Curry) sodden present. The dehumanising is at a boardwalk fun fair with her effects of poverty of environment warring parents. Adelaide wanders are a version of the nature/nurture off towards the beach by herself. debate, the importance of which only The tension is almost unbearable, becomes evident in the final scene. I as we know something bad is going was especially reminded of Harlow’s to happen. As indeed it does – but cruel maternal bonding experiments quite what it was, and its ultimate with monkeys, and that the devices in significance, remain unspecified which they were placed were referred for most of the film. So good is this to as the ‘pit of despair’. Peele is also scene that most of what follows interested in what we remember, cannot quite match the level of and what is forgotten, with forgetting tension, although there are plenty of sometimes being the only strategy scares and morbid humour to be had, for survival. and a lot of (15 certificate) gore. The performances are all Back in the present, the excellent, although ultimately foursome settle in to their summer this is Lupita Nyong’o’s film, who home in Santa Cruz. Adelaide starts seems like a different person when seeing uncanny and unsettling playing her doppelgänger. Us is an coincidences, and becomes entertaining, roller coaster watch convinced that her family should which lingers in the mind. return home. But it’s too late. Another family of four arrive in the Reviewed by Kate Johnstone, dead of night, dressed in red jump Associate Editor for Culture

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play The Son Kiln Theatre

Conveying the nothingness as well as the overwhelmingness I left the Kiln Theatre emotionally drained; The Son is immersive, uncompromising, raw and visceral. I am still reﬂecting on it. The audience is taken on an emotional tsunami of teenage depression, self-harm and suicidality. It focuses on one family’s attempt to deal with the unravelling of

‘Changing the Face of Autism Research Together’ is an arts collaboration between Dr Kinga Bercsenyi, a molecular biologist at Kings’ College London; artist Mario Ruiz Sorube; and podcaster and digital artist, Jon Adams. They teamed up with 21 autism researchers, clinicians, those with autism and family members on an art project, with the aim of stimulating discussion and creating a mindset of openness. Science Gallery London hosted the project in April; more exhibitions are in the pipeline. Read more on our website.

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their son, Nicolas (Laurie Kynaston), against the backdrop of divorce and new family relationships. We first see Nicolas before the play ‘begins’, pacing the stage furiously and scribbling on the walls as the audience are taking their seats. Pain etched on his face. We then meet Anne (the mother, Amanda Abbington), Pierre (her work-focused ex-husband, John Light) and Sofia (his new partner, Amaka Okafor) and their baby. Nicolas hasn’t been to school for three months, Anne is struggling; she’s at a loss and thinks he would be better off living with his father, Sofia and his little half-brother. Sadly, this solution doesn’t have the desired effect and over the next 1 hour and 45 minutes, we track Nicolas’ angst, his hoped for recovery, his relationship with Sofia and his mother’s forlorn efforts to keep hold of her cherished son. Alongside exploring the relationships among the family, old and new, there are brief moments of light; when egged on by Sofia, Nicolas mocks Pierre’s daddancing with his father responding by throwing amusingly impressive shapes. This juxtaposition serves only to illuminate their struggle more profoundly; providing a glimpse of happier times. You really feel each family member’s angst and pain; right down to the pit of the stomach. It took my breath away in parts. Incredible performances all round: Amanda Abbington and John Light are brilliant, you get a sense of what bound them together in marriage, their helplessness to keep their son safe and Abbington’s thwarted desire to have her family back together. Both are utterly captivating. Laurie Kynaston’s take on Nicolas is equally powerful. It is vulnerable and nuanced, conveying the nothingness as well as overwhelmingness of depression and suicidal pain. Amaka Okafor’s Sofia is excellent also, as the new partner who is struggling to connect with Nicolas and understand his emotional pain. The staging is exquisite; the clean, sharp lines and white walls of the Parisian apartment help to illuminate the emotional turmoil of this teenage life which is metaphorically strewn across the stage. After the play, fortuitiously we bumped into the cast and I asked Amanda Abbington how the cast deal with the emotional intensity every night. As she also repeated in a tweet later, ‘we all look after each other and there is a lot of love within the cast and crew. We are aware it is a sensitive matter and take the time to be there. And we care deeply about the play.’ Reviewed by Professor Rory O’Connor, Director of the Suicidal Behaviour Research Lab at the University of Glasgow. The Son is part of a trilogy from French playwright Florian Zeller: see also our review of The Father in the April issue. If you are affected by suicide or you are worried about someone, Samaritans is available 24/7 on 116 123 or via email jo@samaritans.org. Find more resources in our online archive.

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the psychologist may 2019 culture

Diving deep into the emotional underworld Javid Arpoor’s programme, based on his online research, is crafted around three characters he creates to illustrate his findings. His insights show how artists can add value to the psychological task of understanding the root causes of extremist violence. Javid deep-dives directly into the emotional underworld in which extremist identities are forged, confirming what other professionals have concluded: that the drivers of extremist violence are not ideology as they would have us believe, but rather a deepseated and curated hate for those who humiliate them. It comes as no surprise that in a rapidly developing internet age, virtual reality can be experienced as more fulfilling for some individuals than the real world. For those males in particular who have failed to succeed by the standards of the culture that defines them, the virtual world can provide proxies for what they lack at the same time as someone else to blame. This applies to two of Javid’s characters, though the third is more sinned against than sinning in as much as his fate is sealed when he is misperceived as a jihadi on his return from a mercy mission to Syria, thereby beginning a downward spiral into an eventual martyr’s death. The failed foreign fighter is also familiar. He seeks glory in Syria but fails to make the grade and becomes increasingly marginalised from the action, eventually gravitating to a tech role manufacturing propaganda for Al Hayat media when all other options have been exhausted. We last see him in a remote part of northern Iraq, having escaped from the fighting in Syria. We know that this will not end well. For me, such stories of Islamist jihadis who transition from the online to the ofﬂine space are familiar, but what was new to me was Javid’s last character from the Alt Right who graduates from gaming to cyber bullying, becoming embedded in the virtual world and able to peddle his menace from the comfort of his own bedroom. We learn that the tech savvy from the Alt Right have developed a sacralised narrative that not only blames the

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‘grey zone’ of liberal values and democracy for denying them access to their birth right of ‘a car on every white man’s drive and an Aryan woman in every white man’s bed’, but also sacralises their mission as a ‘beta’ uprising in the name of Kek, the ancient Egyptian god of chaos, in the service of whom they believe they are able to reach through their computer screens to alter the social DNA of their enemies. They achieve this through ‘doxing’ – ‘searching for and publishing private or identifying information on the Internet, with malicious intent’. Their victims are women who are beyond their reach, who are blamed for the ‘incels’ involuntary celibacy, and subjected to misogynistic attack, though the incels’ menace also extends from cyber bullying to the manufacture of fake news intended to inﬂuence the outcome of elections. This video raises for me the following questions: • How can society track down such individuals who operate largely on the dark web and bring them to justice? Does our legal system provide enough protection to those who are the victims of cyber bullies? Is further legislation required? • What role does the internet play for women? They are less entrained by video games and have different cultural expectations for themselves. • What changes in education and in society at large do we need to make to counter the negative role of the internet and protect young people from becoming either perpetrators or victims? • What are the political implications of these developments in society? Has the liberal elite lost the moral high ground? Do those of us who espouse liberal values and democracy need to be more aware of its fragility?

tv The believers are but brothers BBC4

Reviewed by Monica Lloyd, a Chartered Psychologist and Senior Lecturer in Forensic Psychology at the University of Birmingham

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The will of war David Lewis-Hodgson on how both sides in World War I sought to explain and ‘treat’ its trauma.

he declaration of war in August 1914 was greeted on all sides with a euphoria so delusional German psychiatrists dubbed it Mobilisation Psychosis (Mobilmachungspsychose). Public opinion was united in the belief there could be no better cure for ‘nerves dried up…from years of peace’ than the ‘mighty healing power of the iron bath [Stahlbad] of war.’ During the early months of fighting it seemed such optimism might be justified. Psychiatrist Otto

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Binswanger recounted how, in the year leading up to the outbreak of war, he had treated a ‘whole series of weak-nerved youths …who amounted to nothing more than whiners. Then came the war. The illnesses fell away in an instant…the great purifier war has done its work’. As the swift victory, initially predicted on all sides, turned into the stalemate of trench warfare, it rapidly became apparent that mechanised conflict broke minds as well as bodies. Within months, the hospital wards of combat nations were filled with soldiers who, although physically uninjured, were blind, deaf, dumb, or mute,

While the British typically viewed soldiers who suffered mental breakdowns in World War 1 as malingerers or cowards ‘Lacking Moral Fibre’, Germans were more likely to believe they had suffered a failure of the will. These perspectives led to very different treatments and outcomes for the victims of what, today, we would diagnose as Post Traumatic Stress Disorder.

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the psychologist may 2019 looking back

paralysed, plagued by tics and tremors, had limbs contorted by violent seizures or bent at an acute angle (a condition known as Camptocormia). By the winter of 1917, neuroses had risen to the point of parity with physical injuries – up from 14 per cent of all injuries in 1914 to 45 per cent three years later. ‘Their number has grown and grown,’ psychiatrist Robert Gaupp reported late in 1917. ‘Scarcely is one nerve hospital opened than it fills up and space must be found somewhere else…nerve hospitals are practically the only ones that are always full.’ The rise of ‘Railway Brain’ German doctors initially attributed the seemingly incomprehensible disabilities confronting them to what they termed ‘railway brain’. This had been coined during the 1880s by Germany’s most eminent neurologist, Hermann Oppenheim. After treating numerous survivors of collisions between speeding trains, he concluded the tremors, tics, stutters and partial paralyses from which they suffered were caused by minute and undetectable brain lesions. After war broke out, he extended his theory to include the effects of explosions from bombs, mines, grenades and artillery shells. Reluctant to accept their soldiers could ever suffer anything as ‘unworthy’ (unwürdig) as a mental breakdown, German doctors eagerly accepted this theory and even began distinguishing between the different types of lesions. Some, they thought, were caused by Granaterschutterung (shell explosion), others by Granatexplosionslahmung (shell paralysis) or Granatfernwirkung (the indirect effects of an explosion). Oppenheim’s theory was not seriously challenged until the summer of 1916. In an influential paper, published in The Lancet, Dr Harold Wiltshire, a captain in the Royal Army Medical Corps, wrote that his patients’ disabilities were the result not of ‘lesions’ but the fact their psychological resistance had been exhausted by the stress of combat. Although initially rejected by the military, Wiltshire’s conclusions received support from other front-line doctors and psychologists. Among those who supported his view was Charles Myers, a medically trained psychologist, based at a hospital in Boulogne, who first coined the phrase ‘shell shock’. The rise of hysteria For clinicians who found the notion of ‘microscopic lesions’ unhelpful, a second and more ancient diagnosis was open to them. Hysteria. The Ebers papyrus, an Egyptian medical treatise dating from 1550 BC, describes how emotional disorders among women are caused by their womb moving from its normal position in the body and disturbing the natural motions of the mind. Centuries later, Greek physicians took the same view and named

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such disturbances ‘hysteria’ from their word hysteron for womb. From the 18th century onwards hysteria was increasingly viewed as a disease not of the uterus but of the nerves. By the early 20th century, doctors were using hysteria to explain away any disturbance of bodily function for which no organic cause could be discovered. For many German doctors, hysteria’s root cause was a failure of the will. As Karlsruhe physician Willy Hellpach put it: ‘The A to Z of hysteria is the will’. The nature of the will Germans regarded ‘will’ as a sublimely masculine quality associated with patriotism, obedience, discipline, and Max Nonne treating patient by hypnosis comradeship. ‘The activity of from 16mm training film the will is raised to the highest conceivable level through love of Fatherland’, wrote neurologist Alfred Goldschieder in 1915. Doctors began attributing disabilities to Willenssperrung (‘inhibition of the will’), Willensversagung (‘failure of the will’) or Willenshemmung (‘an arrest of the will’). As a result, soldiers diagnosed as ‘hysterics’ were viewed not merely as having ‘inferior nervous systems’ or ‘degenerate brains’, but as a threat to national unity and the war effort. The German Psychiatric Association stated as its official policy that a doctor’s sole mission was ‘to serve our army and our Fatherland’ by ensuring every soldier they treated was returned, as swiftly as possible, to the battlefield. In pursuit of this policy, they were given licence to practice any treatment, however extreme, they believed might restore and strengthen a soldier’s will. The rise of active therapies An early form of treatment was hypnosis. A major advocate was Munich psychiatrist Max Nonne, who claimed to perform lightning cures for even the most seemingly intractable disabilities. He had a 16mm training film made to demonstrate his successes (to watch Nonne at work go to www.triumphofthewill.info). Despite his enthusiasm, and his claim to have successfully treated around 1,500 patients over the course of the war, a majority of doctors found hypnosis unreliable and difficult. As a result, most favoured what they termed ‘active therapies’. These ranged from isolation in mental hospitals and prolonged immersion in warm baths to the injection of saline placebos and even pseudo-surgery. One of the most alarming active treatments was

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could end only once the hysterical invented by Essen laryngologist condition had been completely Otto Muck, for use on hysterically David Lewiseliminated. To stop prematurely, dumb soldiers. It involved thrusting Hodgson is a Kaufmann warned, ran a risk of a one-centimetre-diameter steel former lecturer in convincing the patient he was ball into the back of the throat. It psychopathology incurable and so making his was then pressed forcefully against in the Department condition permanent. the larynx until the patient, fearing of Experimental While claiming a high degree suffocation, let out a wild shriek Psychology at the of success for his treatment, which of terror. Muck claimed a high University of Sussex, and Chairman he called Gewaltsuggestionsmethode success rate for his method and of Mindlab International, based in (method of violent suggestion), reported that, far from being upset the University’s Science Park. His and despite it being responsible for by the violent assault, his patients latest book, Triumph of the Will? the deaths of at least 20 soldiers, expressed only gratitude for what he (MLI Press), discusses the ways Kaufmann admitted that none of his had done. mentally ill soldiers were treated patients had ever been fit enough to Another eminent psychiatrist, during the first war and how this return to the Front Line. Otto Binswanger, employed social played a role in the political career It was not until towards the isolation. Patients were commanded of Adolf Hitler. end of the war that resistance by to remain completely silent at www.triumphofthewill.info patients (in one instance leading to a all time and punished, by being david@themindlab.co.uk mutiny) became so widespread and deprived of food, if they even well-publicised that electric therapy whispered. was finally prohibited by the medical authorities. Berlin psychiatrist Ewald Stier used solitary While these treatments now seem appalling to us, confinement cubicles inside a mental asylum. it must be remembered that doctors of the period had Patients were warned that, if they failed to make minimal understanding of psychological trauma and swift recoveries, they would be transferred to a ward their treatment options were very limited. It should filled with violently disturbed inmates. When soldiers also be borne in mind the Germans executed only 18 protested they were not mentally ill, Stier would retort soldiers for cowardice. The British shot 306, including brusquely: ‘He who does not have control over his some teenage boys, many of whom were undoubtedly body belongs in the asylum.’ suffering from PTSD. Between 1914 and 1918, German psychiatrists and psychologists were, in the words of American historian The ‘Kaufmann Method’ Key sources Paul Lerner: ‘Judge, teacher, and disciplinarian . . . The most widely used form of [able] to exercise a decisive influence over the fates of ‘active therapy,’ however, involved Key sources on war enthusiasm in UK thousands of soldiers. They used their…control and administering prolonged and and Germany include: M. Eksteins, Rites authority over the patient to promote medical views painful electric shocks. This was of Spring; R.N. Stromberg, Redemption of German manhood, which were based on duty, known as the Kaufmann method. by War; and R. Rürup, Der Geist von 1914 obedience and, most of all, productivity.’ In 1903, while working in Deutschland. Gaupp, R. (1911). Über den Begriff der With the best of intentions and the most at Heidelberg’s nerve clinic, Hysterie. Zeitschrift für die Gesamte honourable of motives they inflicted pain, suffering psychiatrist Fritz Kaufmann Neurologie und Psychiatrie, 5, p.464. and sometimes death on men crippled by the horrors watched a young girl with hysteria Goldschieder, A. (1915). Über die of the Front. In attempting to treat mental problems make an immediate recovery Ursachen des günstigen Gesundthey did not understand, they wrote one of the darkest after receiving a ‘merciless’ heitszustandes unserer Truppen chapters in 20th century psychiatry. ten-minute burst of electric im Winterfeldzuge. Zeitschrift für Physikalische und Diatetische Therapie current accompanied by strong 19, p170. verbal commands. Twelve years Lerner, P.F. (1996). Hysterical Men: War, later, in the overcrowded wards of Neurosis and German Mental Medicine, Mannheim’s nerve clinic, he decided 1914 -1921. Unpublished PhD thesis. to use the same procedure to create Colombia University, Graduate School of an ‘assembly-line’ method for Arts and sciences. Rather, L.J. (1965). Mind and Body in treating neurotic soldiers. Eighteenth Century Medicine. London: A powerful electric current was Wellcome Historical Medical Library. applied, in bursts of between two Wiltshire, H. (1916). A Contribution to and five minutes and for up to two the Aetiology of Shell Shock. Lancet 1, and a half hours, directly to the p1208-1209. affected part of the body. A soldier Weichbrodt, R. (1918). Einige Bemerkungen zur Behandlung von with a paralysed leg, for example, Kriegsneurotikern. Monatsschrift für would have the electrodes attached The ‘Shooting House’ in Pasewalk, a former restaurant and Psychiatrie und Neurologie Vol. 43, p266. to his thigh or calf. rifle range requisitioned by the German military in 1915 for Once begun, the procedure use as a mental hospital.

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08/04/2019 12:07

the psychologist monthyear looking back

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We dip into the Society member database and pick… Peter Cummins Consultant Clinical Psychologist/Psychotherapist, transitioning into retirement One book Stoner, by John Williams… the most wonderful portrayal of a life. You keep wanting him to change, but gradually grow to accept that he is as he is. As one of the back cover reviews says, ‘A book for everyone, democratic in how it breaks the heart’. One exhibition ‘I am Ashurbanipal: King of the World’, at the British Museum, recommended to me by my older son. The level of detail in the carvings and the clay tablets of Ashurbanipal’s great library, ‘the first in the world to be created with the ambition of housing all knowledge under one roof’, were wonderful. One moment that changed my career Being told by the Bexley Unit General Manager in 1993 that my post as Director of Mental Health was being abolished. After the shock I came to realise that my core identity was as a psychologist. The contrast pole of General management stayed with me throughout my career in Coventry, and deepened my appreciation of being a psychologist. One rewarding thing about my job I only need a quiet room and myself to work with another in the creation of a therapeutic relationship. No other technology required!

One piece from The Psychologist George Kelly and the Garden of Eden, by Trevor Butt, in March 2012.

one on one

One inspiration Actually two. 1. My mother was a teacher of emotionally disturbed children, and completed a London University External degree in Psychology while I was an undergraduate in the early 1970’s. The demands of her teaching job put me off that, but her interest in psychology facilitated my own. 2. Miller Mair, who showed me the true possibilities of Personal Construct Psychology when I was a probationer at The Crichton Royal, Dumfries. His inspiration has been central to my subsequent 43 years as a Clinical Psychologist, and led me to co-construct the Coventry Constructivist Group. One place The Blasket Islands, off the coast of the Dingle Peninsula, in County Kerry, Ireland. I have been absorbed by the literature produced by the residents of the Islands, since childhood holidays in the 1960s, and finally managed to visit the islands about 10 years ago. One thing about the Society It protects my professional identity as a Clinical Psychologist… no easy task at present, given the pressure to reduce everything to a generic task.

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… …May 2012, a special feature on replication. How has the field progressed in the last seven years? Search it and so much more via www.bps.org.uk/thepsychologist psy 05_12 pOFC_Layout 1 16/04/2012 13:28 Page 1

One publication I am proud of Working with Anger, which I edited for Wiley in 2006. My colleagues and I described a model that didn’t entail having your anger ‘managed’.

One thing I would change The domination of Cognitive Behavioural Therapy, given that most practitioners do not seek CBT for themselves!

One thing that intrigues me We have been able to fill the Coventry Foundation Course in Personal Construct Psychology for the last 15 years simply by word of mouth, despite the dominance of CBT.

One thing psychologists should be proud of Carrying on the legacy of George Kelly in having coherent theory that sets out to describe the ways people actually function – rather than presuming that they are ill.

One alternative career path I spent two years in a Roman Catholic seminary training for the priesthood in the late 1960s. I later found out that this was quite a common pathway to clinical psychology!

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coming soon… big data in the big city; notes from a weather watcher; plus all our usual news, views, reviews, interviews, and much more...

the

psychologist vol 25 no 5

may 2012

Replication – psychology’s house of cards? An ‘opinion special’ on a cornerstone of science

Incorporating Psychologist Appointments £5 or free to members of The British Psychological Society

letters 330 news 338 careers 382 looking back 394

interview with Trevor Robbins 360 origins of the human cultural mind 364 analytical decision making 390 one on one with Richard Freeman 396

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President Professor Kate Bullen

Find out more online at www.bps.org.uk

President Elect David Murphy Vice President Nicola Gale Honorary General Secretary Dr Carole Allan Honorary Treasurer Professor Ray Miller Chair, Membership and Standards Board Dr Mark Forshaw Chair, Education and Training Board Dr Juliet Foster Chair, Research Board Professor Daryl O’Connor Chair, Professional Practice Board Alison Clarke Chief Executive Sarb Bajwa Director of Communications Rachel Dufton (Interim) Director of Corporate Services Mike Laffan Director of Member Services Annjanette Wells (Acting) Director of Finance Harnish Hadani

society notices Social Psychology Section Annual Conference York, 28-30 August See p.42 Psychotherapy Section Annual Conference London, 18 October See p.47 CPD workshops 2019 See p.52 Division of Counselling Psychology Annual Conference Cardiff, 28-29 June See p.68 BPS conferences and events See p.74

Director of Policy Kathryn Scott

The Society has offices in Belfast, Cardiff, Glasgow and London, as well as the main office in Leicester. All enquiries should be addressed to the Leicester office (see inside front cover for address). The British Psychological Society was founded in 1901, and incorporated by Royal Charter in 1965. Its object is ‘to promote the advancement and diffusion of a knowledge of psychology pure and applied and especially to promote the efficiency and usefulness of Members of the Society by setting up a high standard of professional education and knowledge’. Extract from The Charter

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