the
the psychologist
psychologist july 2019
july 2019
Alcohol The complex worlds of use and misuse Also‌ reports from the Annual Conference www.thepsychologist.org.uk
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the
the psychologist
psychologist july 2019
july 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 june 2019 issue 47,995 dispatched cover Jon Sutton environment Printed by Warners Midlands plc on 100 per cent recycled paper.
Alcohol The complex worlds of use and misuse Also… reports from the Annual Conference 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.
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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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 july 2019
20 Debunking the ‘natural order of things’ A keynote from Professor Kate Pickett opens the Society’s Annual Conference, and our coverage
32 ‘Everyone has something to add to this conversation’ Introducing a special feature on alcohol use
10 News Education pressures, changing workforce and reality television
36 Challenging the language of alcohol problems James Morris and Claire Melia
14 Digest Including podcast news
02 Letters Climate change, men, and much more
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40 ‘Your number one problem substance is alcohol’ Michael Kelleher 44 Finding moderation online Emma Davies and colleagues
48 A threadbare patchwork of support Will Haydock on the front line
54 Careers We meet counselling psychologist Jasmine Childs-Fegredo, and sports psychologist Hannah Newman 60 Jobs in psychology
64 Books Q&A with Nathan Filer
70 Culture Edvard Munch and more
76 Looking back Carolyn Laubender on Bowlby and the Cold War 80 One on One… with Mike Eslea
This month we have a special feature on alcohol use, and I’d like to take this opportunity to invite you to raise a glass of some sort to Dr Christian Jarrett. He moves on this month after more than 16 years as the founding editor of our Research Digest. Christian has constantly driven the Digest on, from its early days as an email service aimed largely at sixth form students and their teachers, to a blog with a skilled team of writers, a strong social media presence, live events, a podcast (see p.17) and more. We bring psychology, and the Society, to millions of readers across the world each year. Through extensive media coverage, publishing partners and imitators I believe it’s no exaggeration to say that the Digest has changed the way evidencebased psychology is communicated to diverse audiences. Christian leaves with a legacy and our very best wishes. Viewing our glass as half full, there will now be opportunities to help take the Digest into its next era: keep an eye on the blog. Dr Jon Sutton Managing Editor @psychmag
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Getty Images
Taking action on climate change and environmental degradation
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We have recently seen increased media focus on climate change and environmental damage. In particular, Extinction Rebellion, a UK socio-political movement, has received a huge amount of press, media and political attention in response to its peaceful protests against our handling of the climate crisis. This is possibly as they have gone beyond relying on statements and turned to action, engulfing London streets, causing road disruptions, bringing traffic to a standstill in such major London thoroughfares as Oxford Street, Marble Arch and Waterloo Bridge. Other activists glued themselves to trains and London Stock Exchange to call the public and financial industry to act. The media has also paid attention to the international School Strike for Climate, Friday’s for Future, David Attenborough’s recent programme Climate Change: The Facts, and last year’s IPCC report. We are seeing activists of different ages and from different backgrounds united by the same realisation – ‘climate change is real and we need to act now’. Their uniting calls are, firstly, for the Government to tell the truth, secondly to act now and thirdly to go beyond politics. And we are seeing some degree of positive response: MPs recently endorsed a motion to declare a climate emergency; there is talk in the US and the UK of a Green New Deal; and in Australia political campaigns
have paid greater attention to climate damage. The awareness around the globe is rising but what about us? Are we psychologists doing enough? While this feels ‘new’ in some regards, it isn’t. Psychologists have long been aware of climate change and the urgent need to engage, with calls for greater engagement in the pages of this magazine on numerous occasions (including articles by Spence and colleagues in 2009, Rhodes in 2016, and a cover feature from Cameron Brick and Sander van der Linden just last year). Psychologists have long reported that changes in the environment and climate have negative effects on mental health and wellbeing (for example, see Page and Howard in Psychological Medicine in 2010), and this is especially so in relation to already vulnerable populations. We know that the aftermath of natural disasters results in post-traumatic stress disorder and major depression (see for example Galea, Nandi, and Vlahov in Epidemiological Reviews in 2005) and moreover, psychologists have long recorded the ways in which environmental degradation evokes emotional responses such as helplessness, anxiety, guilt, despair and grief (see Norgaard’s 2009 World Development Report, for example). Perhaps we need to speak this truth more loudly and more effectively. We may need to be more assertive in our calls for action too.
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the psychologist july 2019 letters
Despite our efforts to this point, the need to be consistently involved is becoming ever more urgent. How can we sustain and enhance our involvement? How might we be more effective in the communication of what we know? How can we support those involved on the front lines and explore the reticence of many others? These are important and urgent questions for researchers and practitioners to work on. It is time for another call for psychologists to take a more active role in this movement and utilise the momentum to share what we know. There is expertise within the BPS community but we need to offer greater time and attention to climate change and other environmental issues. And this is for all of us, not just high-profile officers of the Society, but practitioners and researchers alike, established professionals and trainees too. That may mean starting from a therapy room, mindful that a wider context could be a reason for distress, or supporting clients that bring climate and environmental related issues as key concerns. Or, we might put some thought into the support that brave and courageous activists at the forefront might also need, coming face-toface with these anxiety-provoking and distressing facts in such a sustained and intense manner. At another level, it might be helpful to consider a new forum for BPS psychologists and our environmental work, rather than expecting this work to be subsumed into the partisan interests of existing Sections and Divisions. Until that happens, we might more formally require all Divisions and Sections to consider the impact of climate change upon their core foci at meetings and conferences. Outside of the profession we probably have more of a contribution to make than we realise. We can draw on community and political expertise to consider community workshops providing space for people to explore their responses to climate change and encourage pro-environmental behaviour. Some members might design services with ecological issues in mind or actively contribute to political work, feeding into consultations, supporting formal party policy development or working with grass roots organisations. Unquestionably there are many ways we might get involved, and without doubt the specific contributions are up to us to consider. However, not engaging, not thinking and not acting is probably not an okay thing to do, not an option that we have as individuals let alone for our profession. Not to be involved would amount to an abdication of responsibility. Maya Gimalova Counselling Psychologist in Training Regent’s University London Martin Milton Professor of Counselling Psychology Regent’s University London
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Supporting new fathers Having read Viren Swami’s article ‘Dads get sad, too’ in the May issue I felt inclined to add my own observations to support Swami’s heartfelt experience of paternal postnatal depression experienced when his own son was born. Bringing awareness of postnatal depression experienced by fathers to the forefront of research and clinical expertise is vital to understanding adult male mental health. I work primarily in adult male inpatient settings and the number of service users who are experiencing symptoms of depression following the birth of their children have, in my opinion, increased. Whether knowledge of fathers experiencing postnatal depression has increased, or the sheer number of cases has risen is not clear. What is apparent is that like Swami, these males are not given much acknowledgement or information. Masculine stereotypes that males should be providers and happy after their child’s birth often leads to self-help amongst men struggling to adjust post-birth, for example through gambling, smoking, drinking and drug-taking. John Condon, Philip Boyce and Carolyn Corkindale’s 2004 ‘first-time fathers’ study found that fathers experiencing depression post-birth of their children were more likely to engage in risk-taking behaviours. As Swami suggested, these risk-taking fathers may be avoiding seeking help, and taking risks in a bid to manage how they are feeling. Behaviours such as taking illegal highs or alcoholism can be maladaptive, leading to a father’s isolation from his new family. Too often I see males in inpatient settings not being supported in the right way. Usually these patients are given game activities to engage in and medication but there is a lack of psychological input addressing the factors centred on their postnatal depression. Support in this way can benefit new fathers who have been admitted to inpatient facilities, reducing the amount of time they are isolated from their new families. I support Swami in arguing for greater attention to the support required for fathers who experience postnatal depression, and argue for action to be taken to support new fathers in our services. Jasmin Kaur Gill Assistant Psychologist, Leicester
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What are the unique skills? I write to stimulate debate at a time when resources are precious and the number of distressed people seeking mental health care through their GP is ever increasing. Practitioner psychologists have, over recent years, been in situations and departments within the NHS where their skills and competences have been ‘portioned off’ and replaced by CBT and IAPT therapists. Psychologists’ competence in formulating is informed by theory, taking into account the person in their situation. Psychologists working in the NHS and other settings have developed complex work portfolios. Their perspective is generally an awareness of the use of diagnosis, whilst preferring to assess their clients using formulations. Has anyone stopped to reflect on the role and function of the psychiatrist? This is a profession that can prescribe complex medication which is often essential in situations
where human distress has become out of reasonable control. With the growth of early intervention teams, the use and need for ongoing psychopharmacology has reduced. The psychiatrist can of course diagnose, and yet so can the psychologist, so this is no longer their unique skill. The concern then is that much available resource is in the employment of psychiatrists, which may be more prudently spent on more psychologists, CBT therapists, counsellors and other IAPT professionals. These people can work in tandem with fewer psychiatrists according to the required professional competences of the demands of the situation. In this way, resources may be appropriately spread, rather than perpetuating a regime that may itself be becoming questionable in its use. This argument also concerns and involves the way in which diagnosis
and its subsequent prescribing is becoming an over-used response to psychological distress. Furthermore, medical responses from GPs will follow NICE guidelines which usually include both talking therapy and medication. The former often results in people waiting for therapy as there are insufficient psychologists or other mental health professionals available. A redeployment of resource away from psychiatrists and towards other mental health professionals as described above would help people with mental health issues of whatever severity to reach psychological help that addresses the uniqueness of each person and their situation. Pam James Professor of Counselling Psychology in Independent Practice Southport pamjamesr@aol.com
How do we define masculinity?
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Martin Seager and John Barry seem to deploy a traditional ‘not all men’ argument in their response (June issue) to Carol Murphy’s letter about murder-suicide in the April issue. This seems unscientific. The fact that the base rate of murder-suicide perpetrated by men is low, is not enough to say male gender conditioning has nothing to do with it. The rate is much higher than the rate of murder-suicide perpetrated by women, which is close to zero. Therefore, the difference between male and female conditioning (or genetics, but that seems unlikely to me) must be a key factor in the different rates of murder-suicides by emotionally damaged men vs. emotionally damaged women. Perhaps there is a question of defining masculinity in these debates. Seager and Barry are keen to talk about protectiveness vs destructiveness. I would suggest that those are two facets of the masculine stereotype. It is not prejudice to talk about both. Susan King, CPsychol, AFBPsS Nottingham
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I was surprised by the complimentarian and conservative position that the Male Psychology Section seems to hold as expressed in the letter from Martin Seager and John Barry – ‘Toxic acts, not toxic masculinity’. Whilst I agree that men can be easily stigmatised as dangerous people I am concerned by their description of masculinity. Defining masculinity in terms of ‘offering protection to women, children, families and communities’ is very limited. It overlooks the fact that many women step up to protect others – men, women and children in paid and unpaid capacities. Furthermore, viewing women as people who primarily need protecting by men leads to inequality between the genders, and oppression of
women, as I experienced when working in Afghanistan. Instead of contrasting the ‘destructive’ acts of a few, with the ‘protective’ acts of many men, the authors could champion men’s ‘constructive’ acts of partnership. As a woman, I want men to work with me, as equals, to make the world a better place together. On occasions they may protect me, as I hope I would protect them, but let’s not make ‘protection’ a defining aspect of masculinity. Let’s change the narrative from destructive / protective acts to the constructive things we can do together. Going forward can the Male Psychology Section challenge prejudice and bias against men, without resorting (however unintentionally) to disadvantaging women? Faith Newton School Based Occupational Therapist Gloucester
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the psychologist july 2019 letters Tim Sanders/www.timonline.info
Questions we need to ask Like many others I was shocked and saddened to watch the Panorama documentary exposing the abuse of individuals within the field I have worked in for the last ten years. It is a shame to think that despite the widespread attention the Winterbourne View abuse scandal received, it appears the subsequent reaction was insufficient to prevent this situation from occurring again. In 2011, responses included vilification of the perpetrators, criticism of organisational ‘culture’, and calls for governmental action. Recently, I have observed similar reactions from both professionals and the public, and therefore am not hopeful for a different outcome. As a psychologist, what I believe is essential, is the professional curiosity and compassion we apply when working clinically, asking the questions ‘why?’ and ‘how?’. I appreciate the automatic emotional reaction to criticise, express
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disbelief, and distance ourselves from colleagues who act this way. Believing ‘we would never act that way’, saying ‘there must be something other about them’, fearing that ‘if we are observed trying to understand their actions, we may be in danger of excusing them’, may be self-preservative; an attempt to protect our own professional and personal identities. Whilst understandable, these reactions are not constructive. I believe it is our role to try to explore, understand, and explain human behaviour. Furthermore, the specialist skillset held by forensic psychologists regarding risk assessment and management has direct utility when faced with the most abhorrent behaviours such as these. Asking questions designed to provoke consideration of the factors involved is the starting point to developing a formulation which may inform future work aimed at
from the chief executive The contribution which psychology and our members make to diverse areas of our society are covered extensively in these pages each month, and we saw one practical application of psychological understanding hit the headlines recently. Unfortunately it took the tragic death of Steve Dymond, who had recently taken part in filming for ITV’s The Jeremy Kyle Show, to bring the standard of psychological care given to participants in reality television shows to the forefront of the public consciousness. We’ve been thinking about this issue for some time, and were able to react quickly to the news by launching our guidelines for production companies and television producers. John Oates, a psychologist who has extensive experience in this field and chairs our Media Ethics Advisory Group, was integral to the production of these guidelines and I hope that his tireless work will lead to significantly improved practices in the industry. This group also provides guidance to producers who do get in touch with the Society seeking our help to make their shows psychologically sound, and it is important that this work is able to reach a wider audience through the guidelines. Human interest stories have been popular since long before reality television, but the format has grown in an era when we also have a far more developed understanding of mental health, and how exposure to the court of public opinion can affect people, particularly when they are not sufficiently briefed, and not given appropriate care by companies which earn a significant amount of money from their appearances. The new series of another ITV show, Love Island, will prove to be an important test of the commitment to providing the right support for people taking part. There have been two deaths of former contestants on the show in the last couple of years, and the producers have pledged to offer a much-improved level of support on this year’s show. I hope that proves to be the case and that the reality television industry begins to prioritise the duty of care it has to its guests above entertaining the public at all costs. Our AGM is coming up in Leicester on 19 July, and you will have a flyer with this issue inviting you to attend. I just want to take the opportunity to reiterate that invitation or, if you are unable to make it, to get in touch with me with any questions or suggestions. Sarb Bajwa is Chief Executive of the British Psychological Society. Sarb.Bajwa@bps.org.uk
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prevention. This piece aims to ask some of those questions. Is it something about the individual within the role that increases the likelihood of resorting to such behaviours? Are people with harmful intent seeking out positions of relative power and isolated access to vulnerable individuals? If this is the case, focus needs to be drawn to recruitment processes. Use of evidence-based advertising, shortlisting and interviewing techniques may increase the effective recruitment of appropriate staff. The introduction of aptitude and attitude assessments may screen for negative or potentially harmful characteristics. Is it that individuals with similar backgrounds and experiences to those we care for are drawn to the caring profession; for example, adverse childhood experiences,
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relationship instability, trauma, and exposure to violence? Often those facing the most direct contact with our client group receive the least training and support. If so, would the profession benefit from more attention being paid to the mental wellbeing of those we rely on to care for possibly the most challenging and complex individuals? Are healthcare jobs seen as an ‘easy option’ with high application success rates, low qualification requirements and low experience expectations, drawing in apathetic individuals, who prioritise money over healthcare provision? Does this lead to a culture of inaction, the bystander effect we are all aware of, so that when one person oversteps the mark, there is no repercussion, no action, and by lack of a response such behaviour is sanctioned? Or is the environment to blame, creating this faceless ‘culture’ the media refers to. Drawing upon my experience within healthcare I think there are several proximal factors which may benefit from consideration. Those working in secure environments are often exposed to violence perpetrated against them; they experience normalisation and expectation of workplace violence and subsequently experience high threat perceptions and high levels of arousal. Is the behaviour we’re seeing an unacceptable and abusive extension
of the ‘gallows humour’, with which those working within challenging environments may be familiar? A slow and steady overstepping of boundaries; difficult to perceive and even more difficult to backtrack from? Is it this, combined with the barrier to physical contact having been broken down due to the use of physical restraint? Do employees lose sight of the outside world through working within an isolated, insular and depersonalising environment where, in the interests of relational security, they are actively discouraged from bringing their personal lives into work? Employees lack reminders of their outside lives such as the photos and keepsakes that many officebased staff are accustomed to. Or, as is so often the case within risk assessment, is it that a constellation of factors, proximal and distal, individual and environmental, were involved in the creation of the perfect storm? Yes, asking these questions is difficult, yes they are uncomfortable, but I believe it is our responsibility to ask and possibly even to answer these questions: to use our professional skills and experience to try to understand and explain these behaviours, in order not to excuse, but to prevent. Dr Sarah Ashworth Forensic Psychologist Nottingham
Letters online: Find more letters at www.thepsychologist.org.uk/debates, including: Psychologists in leadership roles: Narinder Kapur looks to ensure excellence and accountability in people management. ‘Last year’s Independent Inquiry into the self-immolation of nurse Amin Abdullah following his unfair dismissal was accompanied by a recognition that similar management failures were common in the wider NHS and affected staff wellbeing, especially for whistleblowers and BME staff. Recommendations introduced by NHS Improvement in light of this include that regulatory and professional bodies review their guidance for healthcare professionals such as psychologists who take on management roles, especially those relating to staff and disciplinary processes…’ Read more at thepsychologist.bps.org.uk/psychologists-leadership-roles Deadline for letters for the August print edition is Friday 28 June 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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www.jobsinpsychology.co.uk If you are looking for a change in career or just getting started, the BPS job site has the latest vacancies in all areas of psychology throughout the UK and overseas. Register on the site today to be notified of new jobs in your area. If you need to advertise your vacancies, please contact Kai Theriault t: 01223 378051 e: kai.theriault@cpl.co.uk 62
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Too much pressure Getty Images
Report on higher education staff shows that many are having a hard time
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To read the full report see: tinyurl.com/ y5we2kez
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niversity staff are seeking counselling and occupational health support at staggering levels, according to a Higher Education Policy Institute report. Author Dr Liz Morrish highlighted precarious contracts, spiralling workloads and the use of individual metrics as part of the reason behind the deterioration of mental health among many academics. The report Pressure Vessels: The epidemic of poor mental health among higher education staff outlines the result of a Freedom of Information survey of almost 60 universities. This revealed an increase in staff demand for counselling services of 293 per cent, and in referrals to occupational health services of 165 per cent, between 2009 and 2015. Morrish pointed to a Times Higher Education survey on academics’ work-life balance which found that two fifths of university staff across the world reported working longer hours in the past three years and that academics were twice as likely as professional staff to work 10 or more hours per day. A Times Higher Education article by Professor Gail Kinman is also highlighted, which
concluded that university staff experience a greater rate of stress-related illness than police or medical staff. In response, many universities have turned to staff wellbeing initiatives or even blamed a lack of resilience. Morrish pointed to a 2018 quote by journalist Emily Reynolds on why this kind of reform appeals to university management. ‘Engaging in any other kind of reform, after all, would require institutions to acknowledge that many mental health problems are rooted in the very structures themselves... One requires workers themselves to be responsible for their mental health; the other requires structural support that simply does not exist.’ Among these structural issues are academic workload and audits. New workload management models allot periods of time to teaching, research and administration at the start of each year until an academic’s annual working time is filled. As Morrish wrote: ‘If staff find that their timetables are filled up to contractual maxima at the start of the year, then it is inevitable that they will end up working well beyond this in terms of hours, and stress is the obvious consequence.’
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the psychologist july 2019 news Morrish also pointed to the Research Excellence Framework (REF) and Teaching Excellence Framework (TEF) as sources of academic stress. ‘When academics, both individually and collectively, demonstrate with evidence that workloads are too high to be safe, they are told to work smarter. When they complain that many forms of work are erased or under-counted by the workload model… this falls on deaf ears. When academics point to the incapacitating effects of management by metrics, they are told of a need to be accountable.’ Another area of concern Morrish pointed out was outcomes-based performance management. One key driver of this, she wrote, was the REF leading to a much greater focus on individual metrics. ‘There is anecdotal evidence that universities are using performance management and disciplinary procedures more promiscuously and punitively than ever before.’ Metrics in and of themselves are of great concern and Morrish said they are being relied upon as proxies for quality research. Many academics have outlined their scepticism over their use – Morrish pointed out they can only ‘measure the measurable and can be easily gamed or manipulated’. They may also fail to separate different publication practices across fields – while scientists tend to publish journal articles, those in arts and humanities are more likely to write books whose citations are harder to track. Morris also pointed to concerns that metrics used in the TEF are not direct measures of teaching, instead including graduate salaries and student satisfaction scores which tend to disadvantage Black and Minority Ethnic and female lecturers. Morrish suggested some largely cost-neutral alternative approaches, such as allowing academics a degree of autonomy and trust, with workloads that allow time for ‘scholarly contemplation and experimentation’. ‘A constant theme in interviews with academics is the intensification of workloads and the perpetual requirement to produce more, and faster. Different rates of work and apparent productivity may have little to do with diligence and application, but more about expertise and familiarity, research area and norms of collaborative research or single authorship.’ While those in charge of the REF accept that metrics should be used responsibly and in context, Morrish pointed to the paradox that they still drive promotions, allocation of resources and closures of departments. She also wrote that universities should consider the precarious contracts which are driving away many early-career researchers. Dr Julie Hulme, a member of the British Psychological Society’s Senate Expert Reference Group and Reader in Psychology at Keele University, said in a statement: ‘We need to be thinking at whole institution level, a whole system approach, not just about students - because individuals and systems very much depend on each other in the area of wellbeing. It’s also worth thinking about the impact of supporting students with mental health challenges on staff.’ er
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Putting a price on psychology Education Secretary Damian Hinds recently suggested so-called ‘low value’ degrees should be dropped or revamped by universities. According to a statement from Hinds a new analysis has shown a 25 per cent chance of graduates not earning £25,000 or more after five years – the threshold for repaying student loans. Psychology was one of those degrees singled out in the statement, released by the Department for Education, which pointed out more than a fifth of psychology courses see graduates not reaching the earning threshold within five years. He wrote: ‘Our university sector is world class and we are rightly proud of it. Its reputation is built on trust and when young people apply to go to university it is based on the assumption… that a degree will set them up for a bright future – but today’s analysis shows that isn’t always the case.’ However, many psychologists have pointed out that the five-year threshold does not take into account postgraduate study and the broader value of studying psychology. In a blog post (tinyurl.com/y57ygk8g) Dr Julie Hulme (Keele University), former Discipline Lead for Psychology at the Higher Education Academy, said Hinds’ comments had rankled. ‘Psychology graduates take time (around five years, ironically) to settle into their graduate career… However, as shown by a longitudinal study of psychology graduates from the BPS [British Psychological Society], psychology graduates DO attain graduate jobs, and they do find their psychological studies valuable, even if they work in education, health, business, or marketing, rather than in psychology per se.’ Hinds’ comments came days before the government released its review of post-18 education and funding – also known as the Augar Review. The review pointed out that the lifetime economic return for studying psychology is low for men and women; however, Hulme pointed with hope to the review’s recognition
Damian Hinds MP: ‘low value’ comments of the need to acknowledge a degree’s benefits to society and culture. Hulme said she hoped the government would heed the report’s remarks on social and cultural value. ‘Imagine a world in which no-one studied creative writing, art, or music, and the only beauty in the world was prefaced by a symbol such as £, or $, or €... I’m not disputing the value of maths or engineering; I just think we need a world in which beauty exists alongside technology and trade.’ In preparation for the Augar Review Hulme, BPS President Professor Kate Bullen, and others came up with a briefing on the value of psychology and the benefits of supporting psychology – which was sent to the review’s panel. Some of the evidence-informed benefits they outlined included the fact that psychology brings women and minority groups into science and allows students to develop a broad range of skills. There is also a growing need for psychologists and psychological staff, outlined in the NHS Long Term Plan, and there is an obvious role for psychologists in helping with early prevention of public health concerns such as obesity. BPS Chief Executive Sarb Bajwa said Hinds’ remarks were based on a ‘frustrating and fundamental’ misunderstanding of the value of a psychology degree. ‘Psychology is recognised by UCAS as a STEM subject, which puts it at the heart of the Government’s own productivity strategy. But it also gives graduates valuable employability and psychological skills that are directly transferable into the wider modern workplace.’ er
11/06/2019 11:01
Changing and challenging the psychological workforce
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Technological advances, including the continuous evolution of artificial intelligence (AI), new routes into work and the NHS Long Term Plan are changing the face of the psychological workforce. Two individuals working in the area for the British Psychological Society (BPS) told Ella Rhodes about the challenges and opportunities this creates. ‘These changes we’re seeing in the workforce drive the need to think in new ways about how we train and educate a future-ready, highly skilled and psychologically literate workforce who can utilise their knowledge and practice to meet real world challenges both now and as these emerge,’ said Claire Tilley, BPS Education and Training Manager. The NHS Long Term Plan is driving many of the changes required in the wider psychological workforce, with its focus on increasing access to mental health services. The Society is working
Psychologists should be on the Shortage Occupation List There is a nationwide shortage of psychologists, with vacancy rates on the rise, and the profession should be added to the Shortage Occupation List according to the Migration Advisory Committee. If added, migration rules would be relaxed for psychologists and other professions on the list hoping to move to work in the UK from areas outside the European Economic Area. The last time psychologists were included on the list was between September 2008 and October 2009, and while the committee reports that the number of psychologists in the NHS has been stable since 2009 there were 698 psychologist vacancies in 2016 and 694 in 2017. If psychologists are included on the list it would mean professionals from overseas would not need to meet the salary threshold of £35,800 to settle after five years and would pay lower visa application fees. Psychology is one of the most popular degrees for undergraduate students in the UK and some have pointed to a lack of funding for further training as being partly to blame for the shortage of psychologists. Many who responded to the committee’s call for evidence also pointed to lower EU migration and the uncertainty surrounding Brexit as having an impact on recruitment. er 12
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to develop apprenticeship routes into psychological jobs to fill workforce gaps and open up opportunities to work in the NHS to a broader range of people. The BPS is also offering support and guidance to stakeholders and acting as an advocate for members and the discipline. Tilley said it was important to inform employers of the benefits of a psychologically-informed workforce as well as potential students of the benefits of undertaking psychology education or training. ‘We have an opportunity at the moment to influence huge change, particularly in the Mental Health Workforce through the development of new routes, roles and standards.’ BPS Senior Policy Advisor Sabrina Kamayah added that another way to increase the visibility of psychological professions was to improve clinical leadership and engagement in shaping policy for psychological professions. ‘One suggestion put forward from Health Education England work on new roles is to have a chief officer role for psychology to represent psychological professions across the protected titles at a local, regional and national level. This would also enable parity with other national roles at this level – for example a chief social worker.’ While some of the changes needed in the psychological workforce are predictable, others are far less so. AI seems bound to have a profound impact on humans and Tilley said there is a possible role for psychologists to research the human impacts of technologies such as this. Kamayah added that the face of therapy is changing thanks to technological advances, and while online therapies and mental health apps may increase access to support, many on the market have not been approved by official bodies. ‘Where does this leave vulnerable people if there are glitches in the technology that is being developed? And what does this mean for psychologists who are left supporting people who are engaging with technology in a very different way? This is an area we don’t know enough about yet so it’s key for the BPS to keep a watching brief on AI and to engage with psychologists who are leading in this area.’ As well as changes to the technology used to tackle mental health issues, the make-up of the psychological workforce is set to be shifted as Generation Z (those born between the mid 90s and mid 00s) reaches working age. As Tilley explained, the next generation’s career aspirations and views of career pathways are quite different to those of past generations. ‘Alternative routes through to roles in psychology should be developed to further broaden the appeal of the discipline, to safeguard the professions in the future and to support further diversification of the workforce. It is hoped that a diverse workforce will encourage further engagement with psychology and the many benefits it can offer from a broader cross-section of society.’ er
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the psychologist july 2019 news
An inquiry into reality TV programmes has been launched by the Commons Digital, Culture, Media and Support select committee after three former participants died by suicide. It will explore the support provided to those who appear on such programmes and the duty of care of production companies. The Jeremy Kyle Show was recently cancelled after Steven Dymond, who had taken part in a lie detector test for the programme, died by suspected suicide a week after filming. Two former contestants of the reality dating programme Love Island – Sophie Gradon and Mike Thalassitis – died by suicide in June 2018 and March 2019 respectively. John Oates, Chair of the British Psychological Society Media Ethics Advisory Group and member of the Society’s Ethics Committee, writing for The Conversation, warned of the psychological impact and potential long-term effects of appearing on such programmes. He pointed to allegations of lax screening procedures which can miss mental health problems, ‘winding up’ of participants in green rooms prior to their appearance, and non-existent aftercare.
In 2009 concerns were raised over the programme Boys and Girls Alone which featured children aged 8 to 10 in a Big Brother-style reality show. A subsequent review led to the development of legislation and regulations which considered the psychological risks of under-18s appearing on television. Oates said, ‘I contributed to this on behalf of the British Psychological Society (BPS). Our finding was of multiple risks, including harms such as distress, trauma, negative attitude change, moral damage, lowered self-esteem, embarrassment and loss of dignity, disempowerment, insecurity, anxiety, engendered fears, mental stress/ fatigue, and peer disapproval or bullying’. While this led to changes in Ofcom guidance and regulations there are no guidelines in place for adults taking part in reality TV programmes even when a person may be vulnerable. However, as Oates pointed out, not all reality programmes are the same. ‘Ten years working with the production team for the BBC/ Open University Child of Our Time series opened my eyes to the care taken throughout to ensure that the families were happy with how they
Inspection of education Ofsted’s new education inspection framework lacks a strong enough focus on mental health and wellbeing according to the British Psychological Society. The Society was involved in a consultation response to the framework and called for new mental health and wellbeing measures to be embedded in the school inspection regime along with additional psychological support and guidance for schools. The framework does include reference to mental health and wellbeing but BPS Chief Executive Sarb Bajwa said he was disappointed the reforms had not gone further. ‘Ofsted has missed an opportunity to turn school inspections into a mechanism to inspire real change for children and young people’s mental health and psychological wellbeing.’ Bajwa added that he was concerned that terms used in the framework, including ‘resilience’ and ‘fundamental British values’ lacked clear, accessible definitions that are valid, reliable and measurable. er
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The reality and the duty of care of TV production companies
were portrayed and that a thorough duty of care protocol was followed before, during and for some time after each series. This experience encouraged me to establish the British Psychological Society Media Ethics Advisory Group, made up of a group of psychologists with extensive media involvement.’ Sarb Bajwa, Chief Executive of the BPS, said he was pleased to hear of the select committee review and announced that the BPS would be launching guidance for TV commissioners and producers of the best psychological practice when working with members of the public – particularly with vulnerable people. ‘There are many BPS members who work as psychologists on television shows of all kinds, offering important advice to production teams, psychologically informed aftercare to participants and, crucially, ensuring that potential contributors are screened for mental health issues. We would always recommend that producers enlist the help of an experienced and qualified psychologist to guide them through these vitally important areas.’ To contact Samaritans call 116 123 or email jo@samaritans.org. er
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News online: Find more news at www.thepsychologist.org.uk/reports For much more of the latest peer-reviewed research, digested, see www.bps.org.uk/digest Do you have a potential news story? Email us on psychologist@bps.org.uk or tweet @psychmag.
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Attachment style through the lifespan Christian Jarrett digests the research
Find our Research Digest at www.bps. org.uk/ digest Editor: Dr Christian Jarrett Writers: Dr Matthew Warren, Emma Young and Jesse Singal Full reports and much more on the Digest website
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ttachment theory, which was first proposed in the 1950s by the British psychoanalyst John Bowlby, is one of the most influential in psychology. It argues for the importance of our earliest relationships with our caregivers, and predicts that these formative bonds will shape the nature of our connections with other people for the rest of our lives. Remarkably, however, psychologists still know relatively little about how people’s attachment style – essentially their characteristic style of relating to other people – typically varies through life. ‘How do attachment orientations change across the life span? Unfortunately … this critical question has eluded researchers,’ write William Chopik and colleagues in their recently published paper in Journal of Personality and Social Psychology. Their research is the first to document how attachment style varies, on average, through decades of the lifespan, from age 13 to 72. The results suggest that, like other aspects of personality, attachment style is relatively stable through life, but that it is not entirely fixed, and in particular that it may be shaped by our relationship experiences, as well as the varied social demands of different life stages. ‘The current study is one of the first truly longitudinal investigations into life span changes in attachment orientation and the antecedents of these changes,’ write Chopik and his team. The data come from five historic projects, involving personality surveys of 628 US citizens born between 1920 and 1967. The shortest of these was 9 years and
the longest was 47 years. They all involved participants being assessed repeatedly over many years using the California Adult Q-sort – a measure that includes 100 personality items. Chopik and his team focused on 14 key items from this measure, allowing them to compile scores for ‘anxious attachment’ and ‘avoidant attachment’ for each participant. People who score highly on ‘anxious attachment’ fear rejection and constantly seek reassurance. People who score highly on ‘avoidant attachment’ find intimacy uncomfortable and find it difficult to provide emotional support to others. Low scores on both anxiety and avoidance is a sign of having a secure attachment style. The researchers stitched the data from the five historic samples together, so that they had scores for anxious and avoidant attachment spanning 59 years. Past research has already looked at how people of different ages vary in their attachment scores, but one problem with that kind of cross-sectional research is that any differences between people of different ages could be due to generational differences, rather than due to developmental trends. The new research largely overcome that problem, with Chopik and his team able to identify clear age-related trends in the same individuals over time. Specifically, the team found that people’s anxious attachment tended to be high in adolescence, increasing into their young adulthood, before then declining through life into their middle and old age. Avoidant attachment
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the psychologist july 2019 digest
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Blink if you want to go faster Every few seconds, each time you blink, your retinas are deprived of visual input for a period lasting anywhere between tens to hundreds of milliseconds. You don’t usually notice this because your brain suppresses the dark spells and stitches together the bursts of visual information seamlessly. But these dips in visual processing in the brain do have an impact: a new study in Psychological Science finds that they cause your sense of the passing of time to stop temporarily. Ayelet Landau at the Hebrew University of Jerusalem and her colleagues asked 22 participants to judge the length of time that a circle was shown on a screen, and they
used a video-tracker to observe whether or not they blinked during the presentation. Participants underestimated the duration of the white circle’s appearance if they blinked while they were watching it. What’s more, for each individual, the duration of this blink correlated with their degree of time underestimation. There was, as the researchers write, ‘a proportional relation between the objective duration of sensory-input loss and the loss of subjective time.’ These results, they go on, can be interpreted as ‘supporting a central role for ongoing sensory encoding in the subjective sense of time.’ [Emma Young]
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showed less change with age, but started higher in adolescence and then declined in linear fashion through life. The researchers surmised that attachment anxiety and avoidance may be high in adolescence due to the stressful transition from having primarily close bonds with parents to having meaningful relationships with peers and first romantic relationships. They also pointed out that mid-life – when anxiety and avoidance tend to decline – is arguably the time when we are most invested in various social roles and relationships and that ‘…increases in security often result from people becoming more comfortable in their relationships, gaining more evidence that the relationship will last, and having spouses who serve attachment needs and functions that promote close relations.’ Meanwhile, in later life, when attachment anxiety and avoidance are typically lowest, they said people tend to be very focused on the here and now – ‘declines in anxiety and avoidance may reflect the efforts of older adults to become closer to their close friends and family,’ they said. Another finding from the study was that at all times of life, being in a close romantic relationship tended to go hand in hand with scoring lower on attachment anxiety and avoidance. ‘Romantic partners reward appropriate behaviour and admonish inappropriate behaviour,’ the researchers said. ‘By investing in these social roles, individuals adhere to the rules and appropriate behaviour of close relationships and may change how they approach relationships accordingly, perhaps becoming more secure.’ It’s worth noting that this research looked at group averages, which inevitably masks the idiosyncratic ways that some people may change in their attachment style through life. The study is also limited by only involving participants from the US, the fact that it relied on extracting attachment scores from a measure not designed for that purpose, and that data was stitched together from multiple samples so as to cover the period from adolescence to later life. In a way, however, that last point is also a positive: ‘given the many ways in which these samples differed, the amount of consistency across the samples in estimating changes over time in attachment is even more remarkable. The converging evidence is a testament to the robustness of these results, such that they were found under different conditions in samples collected between 1936 and 2016’, the researchers explained. There is plenty for future research to build on, including looking at how the consequences of different attachment styles might vary at different stages of life, and whether and how early life experiences might interact with the developmental trends identified in this study. The researchers concluded that ‘By examining these future directions and identifying the conditions under which attachment orientations change, we can finally start taking seriously Bowlby’s claim that attachment experiences are important from the cradle to the grave.’
Adopting an ancient rhetorical method favoured by the likes of Julius Caesar and known as ‘illeism’ – or speaking about yourself in the third person – could make you wiser. (PsyArxiv)
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Learning skill by having a break
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A wealth of research has shown that taking breaks is an important part of learning. Resting straight after acquiring new information seems to improve memory of that information, for example, and sleep is particularly important for consolidating what we have just learned. Now it seems that even miniscule breaks, just seconds long, are also vital for learning new skills. A study published recently in Current Biology has found that most of the improvement while learning a motor task comes not while actually practicing, but instead during the breaks between practice sessions. To look at the benefits of short breaks during learning, Marlene Bönstrup and colleagues recruited 27 participants to learn a short sequence of key presses. Across 36 trials, each 10 seconds long, the participants repeatedly tapped out the sequence 4-1-3-2-4 as quickly as possible, using four fingers of their left hand. A 10-second rest period separated each trial. The participants improved drastically across the first 11 trials, increasing their speed from just over 1 key per second to more than 3.5 keys per second. After that their performance plateaued. But when the researchers looked at how performance improved during these 11 trials, they found that, on average, participants were no faster at the end of each trial than they were at the beginning of that same trial. Instead, improvements were made solely between trials: participants were faster at typing the sequence immediately after a 10-second break than they were just before the break. The findings suggest that early improvements when learning a new skill are made ‘offline’, during periods when the task isn’t actually being performed. This is consistent with past studies highlighting the importance of rest periods in learning, say the authors, albeit on a much shorter timescale. ‘These results support the idea that the brain opportunistically consolidates previous memories whenever it is not actively learning’, they write. The team also identified a neural basis for these ‘offline’ improvements. While the participants completed the task, the researchers measured their brain activity using magnetoencephalography (MEG). They found that improvement in performance between trials was related to the amplitude of beta waves (brain waves
between 16 and 22Hz): smaller amplitude beta waves in the frontoparietal part of the brain during breaks were associated with greater improvements in performance. Beta wave activity is known to be reduced while people prepare and execute movements, so the authors suggest that this pattern of activity could indicate some kind of reactivation and consolidation of memory related to the task. The study only looked at performance when people learned a very simple motor task, and it remains to be seen whether short breaks are equally as important when acquiring more complicated skills. But even knowing how to best improve basic motor function could be useful in situations like rehabilitative medicine. ‘Our ultimate hope is that the results of our experiments will help patients recover from the paralyzing effects caused by strokes and other neurological injuries by informing the strategies they use to “relearn” lost skills,’ said senior author Leonardo Cohen in an accompanying press release. [Matthew Warren] Even people without mathematical training can experience the ‘beauty’ of maths, according to research that involved hundreds of participants (most of them untrained in maths) comparing the similarity of four wellknown mathematical arguments to four landscape paintings. The participants tended to agree on the similarity of the various arguments and paintings, suggesting that people share an intuition about the aesthetics of maths, the researchers said. (Cognition)
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the psychologist july 2019 digest
PsychCrunch… podcasting far and wide Our PsychCrunch podcast, sponsored by Routledge Psychology and presented alternately by Dr Christian Jarrett and Ginny Smith, explores whether the findings from psychological science can make a difference in real life. Just how should we live, according to psychology? We speak to psychologists about their research and whether they apply what they’ve discovered in their own lives.
There are now 16 episodes available providing evidence-based advice on: dating and attraction; breaking bad habits; winning arguments; gift giving; learning a new language; being sarcastic; competing like an olympian; getting the best from your team; avoiding procrastination; getting a good night’s sleep; being funny; studying and learning more effectively; and cooking. We also have episodes Getty Images
discussing whether, in light of the replication crisis, we can trust psychological studies; and another on whether mindfulness is panacea or overhyped. Our most recent episode was a bonus programme, presented by The Psychologist’s staff journalist Ella Rhodes, on ‘aphantasia’ – the inability to form images in the mind’s eye. Ella, who has the condition herself, spoke to Zoe Pounder at the University of Westminster and Professor Adam Zeman at the University of Exeter to find out what their research says about the implications of the condition for autobiographical memory, face perception and imagination. PsychCrunch is available to listen to directly via the Research Digest blog (https://digest.bps.org. uk/podcast/) or you can subscribe and download the show through your preferred podcast outlets including iTunes, Spotify, Stitcher and more. Future episodes currently in preparation will share evidencebased tips on running; creativity; coping with pain; and getting promoted.
Will you get your teeth into a Digest role? The Research Digest’s founding editor, Dr Christian Jarrett, is moving on after more than 16 years at the helm (see the editorial which opens this issue). The Digest has enjoyed huge success bringing psychology, and the British Psychological Society, to millions of users across the world. Our challenge now is to ensure we have the team to take it forward into a new era. As we go to print, we are discussing options, but there is likely to be an exciting and flexible role for someone who knows their psychology research, and is skilled in communicating it. Our writers have strong credentials in psychology, plus experience of digesting and critiquing complex scientific research. They trawl the latest journals to find excellent studies which have the potential to engage readers, and change the way they think about themselves and their lives. We provide a rare opportunity for our team to immerse themselves in psychology communication, and an environment and mentoring which allow our team to flourish. In addition to the blog and weekly email roundup, we have successful social media channels, and a regular podcast. We’re confident the Digest will continue to evolve and expand. For opportunities to join us on that journey, keep an eye on the Research Digest blog.
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Debunking the ‘natural order of things’
In introducing the new-look British Psychological Society Annual Conference and its opening keynote from Professor Kate Pickett, current President Professor Kate Bullen promised ‘A series of provocations… to think about problems and solutions’. Here, we present a snapshot of reports from the event, mostly around the conference theme of inequality. Find more on our website.
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he UK has a higher level of income inequality than most developed countries, with around one person in five currently living in poverty. In her passionate and well-received keynote talk, Kate Pickett, Professor of Epidemiology at the University of York, discussed the wide-ranging psychosocial impacts of such extreme inequality. This was an overview of many years of research, as brought into the public eye in two books co-written with her husband, Richard Wilkinson – 2009’s The Spirit Level: Why More Equal Societies Almost Always Do Better, and the long-awaited follow-up, The Inner Level: The Psychological Costs of Inequality. Pickett argued that the costs of inequality cannot merely be gauged from the rise and fall of overall standards of living; the widening gap between rich and poor has a major impact on the wellbeing and social functioning of individuals who live in that society. She highlighted the importance of providing a rigorous, evidence-based but
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Conference photos: Tony Dale
accessible analysis of the human cost of inequality to communicate these findings: ‘people are far less likely to read books that have equations in them – we were told that for every equation you include, you lose 10,000 readers’. The challenges of writing books on social equality were also acknowledged: ‘The Inner Level took six years to write… so much research is being done and the world keeps on getting more unequal, so it is hard to keep up’. Ten years of austerity has led to wage stagnation and increased job insecurity for a high proportion of the population, and there have been cuts and widespread changes to the benefits system and public services more generally. The effects of inequality on public health and life expectancy are widely acknowledged, Pickett argued, but its impact on the mental wellbeing and personal relationships of individuals should also be recognised. She also provided evidence that links inequality to lower educational attainment and social mobility, whereby people have fewer opportunities to transcend their social class. The impact of inequality on children is of particular concern. The amount of time spent in poverty is strongly related to the cognitive development of babies and children. Pickett referred to a UK teacher recently disclosing that around a third of her school’s 350 students would not have breakfast if the school did not provide it. She emphasised the importance of support services such as Sure Start: such schemes can offset some of the effects of poverty and improve children’s educational and psychological performance. Pickett also referred to the rising incidence of mental health problems, particularly among young people: in one study ’83 per cent of 18- to 24-year-olds reported feeling so stressed during the previous year that they were overwhelmed or unable to cope’. Fear, stemming from feelings of low self-worth and self-doubt, is more prevalent in unequal societies and the risk of status
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the psychologist july 2019 annual conference
anxiety is higher at all income levels. ‘This breeds unhealthy relationships’ – people tend to withdraw from social contact with others, there is less trust, less community involvement and less voting participation. Homicide rates, domestic violence and crime in general are also higher under conditions of inequality, with the number of people imprisoned ‘up to 16 times greater’. The age of criminal responsibility for children is also typically lower in more unequal societies. Worryingly, mental health problems are not only more common but also more stigmatised in unequal societies. However, the effects on the ‘inner level’ vary, Pickett argued, with some people ‘going under’ and experiencing low self-esteem and depression, and others seeking to increase their feelings of self-worth. A steep rise in the characteristics that define narcissism in college students in the US, particularly exaggerated over-confidence, was highlighted. People living in more unequal societies are also more likely to use ‘selfsoothing’ behaviours, such as comfort eating, problem gambling and excessive drug and alcohol use, with serious implications for their wellbeing over the longer-term. Consumerism is also much higher under conditions of inequality and there is more advertising spend – unsurprisingly, people are more likely to get into debt. As Pickett commented (quoting from the movie Fight Club): ‘we buy things we don’t need, with money we don’t have, to impress people we don’t like’. Inequality is one of the most pressing issues of our time, and Professors Pickett and Wilkinson are at the forefront of this discussion. Their work goes a long way towards debunking the myth that social inequity is ‘the natural order of things’, ‘the rich are rich because they work harder and are cleverer than the poor’ and ‘we are all just out for ourselves’. Many problems in our increasingly polarised society stem from social inequalities, with widespread costs. The good news is that the negative impact of inequality can be reversed with careful planning and more humane public policies – Pickett and Wilkinson are working with the Equality Trust (www.equalitytrust.org.uk) to build a better society and reduce economic inequality. gk
Funding good questions asked rigorously The face of the world is changing, and the face of research must change alongside it. Sir Mark Walport, Chief Executive of UK Research and Innovation, gave an overview of some of the most pressing challenges currently faced by scientists. With climate breakdown, our ageing populations, the rise in populism and sudden doubting of enlightenment values, science is more important than ever. ‘We need to defend the rigour of science’, Sir Walport said. ‘It is the most powerful way of finding things out that we have. We need to explain it, we need to communicate with the public as we have never done before.’ Walport said investing in people was particularly important – including good training in research and better career advice. He also suggested tracking the career trajectories of researchers after postdoctoral positions. While some remain in their field others take their skills in questioning the world into other areas. Walport said he is often asked why more scientists aren’t MPs. His reply: ‘They stood for election, scientists didn’t’. The UKRI, which comprises seven research councils, was brought together after a review on research councils by Paul Nurse. Many of the councils support psychology research and Walport said social science can be useful in creating a prosperous economy, more effective public services and a more sustainable and healthy society. However, he added, good research is about asking good questions. ‘Research that doesn’t consider big questions the taxpayer is asking is missing a trick… the social sciences do have to work with the third sector, government and business.’
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Karen Parkhill and Nick Pidgeon, and their identification of the ‘energy trilemma’ – while 74 per cent of people were very or fairly concerned about climate change, and 80 per cent said we should reduce fossil fuel use, 82 per cent are concerned about becoming reliable on energy from other countries and 83 per cent are worried electricity and gas will become unaffordable in the next two decades. Policy decisions are viewed in this way: they are difficult and require trade-offs in one or more of those areas. However, psychology has had policy impact. Walport gave John Drury’s work on crowd behaviour and Louise Arsenault’s research on inequality as prime examples. It is important to remember that policy makers are less concerned with single studies: they care more about what a body of research can conclude. Reproducibility, obviously of concern in the field, is more about incompetence than wickedness,
Walport said. ‘There is some wickedness, but a much more systemic problem is people not doing research well enough.’ Underpowered and poorly designed studies, various issues with both overly small and extremely large sample sizes, publication bias and misaligned incentives, a lack of publication of null findings… all these are issues which need attention. ‘This is a case of medicine for everyone.’ Employers should ensure statistics education is up to scratch, and an institution should encourage quality in research, continued professional development and HR support. Funders should embrace rigorous peer review, proper funding, and ‘intelligent transparency’: ‘data without metadata isn’t useful’. As Walport pointed out, in psychology we know about cognitive bias and understand the allure of wanting to believe one’s own hypothesis. Quoting Richard Feynman, he added: ‘The first principle is that you must not fool yourself – and you are the easiest person to fool.’ er
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One way to do this is to look at government department lists of ARIs (areas of research interest). Many of the items on the lists from various government departments are asking questions which psychologists are primed to help answer. Walport gave the example of the Department for Work and Pensions seeking answers on the causes and consequences of family breakdown. Psychology, he said, while pervasive and multidisciplinary, can get caught up in ‘extremely uninteresting debates’ in areas such as qualitative vs quantitative approaches, when both can be done well or badly. ‘We’ll fund science as long as it’s asking good questions in a rigorous way.’ Another important consideration when tackling issues which affect policy is to view the world through as many other people’s lenses as possible. For example, while most people in the UK are concerned about climate change research, tackling the issue isn’t so simple. Walport pointed to the work of psychologists including
Images in the fashion media are seen as influencing a preference for lighter skinned Black women over darker skinned – so-called ‘Shadism’. That’s according to interviews with Black British millenials, by Melanie Larsen (London College of Fashion). 22
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the psychologist july 2019 annual conference
Riding the wave of transformation The ‘Hands across the water’ session, bringing together the British Psychological Society and the Psychological Society of Ireland, has become a regular event at the Annual Conference. This year, an ‘s’ was added, with Amanda Clinton, Senior Director for the American Psychological Association’s Office of International Affairs, bringing them into the fold. Professor Brian Hughes (NUI Galway) kicked off, with his book Psychology in Crisis the backdrop for a rather more optimistic message. ‘We have wonderful opportunities to ride the wave of transformation and progress,’ he said. That change, it could be argued, is overdue. Evoking William James – ‘statistical analysis as we know it is Irish’ – and the contents of his Principles of Psychology, Hughes suggested it is remarkable to be able to recognise that ‘Victorian architecture’ of psychology in 2019. But what of how the masses understand psychology? Hughes turned to media depictions. These often report results with no acknowledgement of the non-human basis (see the Twitter account @justsaysinmice), or rely on well-worn tropes with an eye on web hits. (Hughes pulled up dozens of ‘Is x making you fat?’ headlines, including whether thinking about what makes you fat is making you fat.) ‘This is psychology as most people recognise it,’ Hughes claimed. ‘Trivial ideas are quite popular in society.’ Psychology is a fertile breeding ground for the spurious results which can plague any scientific discipline, according to Hughes. Small samples, small effects, studies of fashionable subject matter, topics where researchers may have personal bias… all in all, what Hughes calls ‘rampant methodological flexibility’. So what’s the solution? The last few years have seen psychology taking a lead in impressive efforts to clean up science in general. But, Hughes warned, ‘none of the open science initiatives create an incentive to replicate’. Only around 1 per cent of papers are replications, and ‘if you don’t do replication, you can’t have a replication culture’. It’s only by redoubling efforts to get our house in order and ‘stand up for psychology’, Hughes concluded, that we can move towards ‘evidence-based social justice’ – an area where, he said proudly, the Psychological Society of Ireland has been ‘vocal and heard’. Representing the UK, Dr Katherine Button (University of Bath) had some fascinating insights on ‘shifting incentives to reward team science’. Currently, those incentives in academia are all about novel, large and exciting effects. The number of significant findings in published papers – particularly the cluster just under p < .05 – suggests psychologists are either ‘asking questions to which we already know the answer, or predicting the future, or…’ Button reported that intense competition and time pressure are cited as the main reasons for irreproducible research, and that in an ‘increasingly competitive
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environment’ there is (according to her own analysis) a ‘premium for being male’ in terms of becoming a Principal Investigator. But it starts early: student projects are ‘a microcosm of these issues’, as the wrong culture becomes embedded at the earliest stage. Button is addressing this through changes to the undergraduate dissertation, with pre-registration as ‘the most powerful thing you can do’. Yet it’s still tricky to put in place a mechanism to reward the allimportant teamwork that many undergraduates display throughout their projects. ‘We need to train psychologists for the future of team science,’ Button urged, including consideration of career paths for ‘skills specialists’. ‘What are the conventions to equally reward the diverse roles that make science work?’ Finally, Professor David Shriberg (Indiana University) considered how social justice has been defined and applied in psychology, especially in educational psychology. How can we ensure the full and equal participation of all groups? Shriberg talked about the ‘goggles’ we wear when we examine practice, research and ethical issues in the field. Then there’s the skillset: the ability to be a ‘constructive irritant’ when it comes to injustice. ‘Stop, listen, observe, question assumptions, show cultural humility, own your need for growth.’ What role do educational psychologists in the UK think their profession should play in working towards social justice? Shriberg pointed to action, politics and policy, and ‘being brave’. This session was a fine example of how collaboration between professional organisations has the potential to shore up our foundations, in order to build real and lasting impact. js
Professor David Shriberg (Indiana University) considered how social justice has been defined and applied in psychology
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Answering questions over Brexit
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One of the most packed symposiums at the conference, organised by the new Political Psychology Section of the BPS, was on the topic of Brexit. Dr Kesi Mahendran (Open University), who has worked in government and studied the public’s relationship with the EU for over a decade, kicked off the talks. She posed a question to the room: should we have another EU referendum? Mahendran sought no answers: instead, she was interested in the various thought processes behind those conclusions and the way we define the rest of the public in our reasoning. Psychologists have an important role in moving situations from polarised public opinion to public dialogue. Part of that is asking how individual members of the public situate themselves in comparison to the rest of the public; or, as Mahendran puts it, ‘how do we generalise the generalised other?’ One of her projects started by looking at EU attitudes in Stockholm and Edinburgh, and was expanded to include Gothenburg, Glasgow, Dublin, Dusseldorf and London. Mahendran and her colleagues carried out faceto-face interviews with 100 citizens who were recruited along a ‘migration-mobility continuum’, with 10 positions ranging from generational non-migrants all the way through to interviews with ‘serial’ migrants who were planning to move again. They talked about various EU ideals, including freedom of movement. She found six prevailing positions on the general public; while some
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Have you considered setting up a ReproducibiliTea journal club? Brewed by Amy Orben, Sam Parsons and Sophia Crüwell, they blend transparency, openess and robustness, a spoonful of science. Here, Emma Norris (University College London) was serving the scheme up as one way of producing change in ‘behaviours occuring in complex environments’. This echoes Norris’ own work to understand and lever people’s capability, motivation and opportunity to change. Full progress will only be made, she warned, if good practice in open science is recognised for career progression.
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people are rather avant-garde viewing the public as a ‘they’ who need to change, others use ‘they’ differently to advocate on behalf of the public, some distance themselves from the public as an oppositional ‘they’. Equally some citizens segment the public in terms of ethnic and national categories. Others see the public as we, speaking of it in terms of a progressive mobile ‘we’, or a more protectionist non-mobile ‘we’. Mahendran is now investigating in her new project how these positions relate to social representations of the public as having freedom through movement, freedom from movement and freedom of movement. Ivett Ayodele (Salford University), who recently completed her MRes in Social Policy, arrived in the UK from Hungary 13 years ago with the intention of saving money and developing her English skills. She has since turned her attention to psychology and to the experience of her fellow Hungarian workers’ experiences of Brexit. Ayodele pointed out something which many have missed: in the mess of debate around Brexit, the voices of millions of EU citizens living in the UK have been largely absent. The uncertainty which has been plaguing these people’s lives should not be underestimated, and Ayodele wanted to dig a little deeper into its impact. She carried out semi-structured interviews with 10 Hungarian nationals who had been living in the UK for at least five years and split her results into pre- and post-Brexit themes. Before Brexit, Hungarians spoke of a motivation to migrate to better their working lives. Some left for love, some for political reasons and others to improve their English language skills. Ayodele found that many experienced barriers to getting jobs, some had to take jobs far below their level of skill due to language barriers or their qualifications not translating. Some were promised jobs by friends and families but these disappeared on their arrival in the UK. Many ended up with low wage jobs working below their level of skill and qualification. After the EU referendum the picture became even bleaker. Many were in shock that the UK voted to leave; they felt a sense of mistrust and as if the country did not want them anymore. They also felt the voting public had been misled by the Vote Leave campaign. They were left feeling uncertain over their future plans including whether to buy a house, experienced racism but often wrote it off as harsh British humour, and felt forced into applying for settled status. Ayodele said the impact of the Brexit vote among the Hungarians she spoke to played out something like a psychological trauma. Honourary Professor Peter Bull (University of York and University of Salford) hit the headlines with his research on the evasiveness and equivocation of Theresa May in response to questions – more so compared to the past four Conservative PMs. Bull and his team have identified 36 ways of not answering questions. These can be broken down into 12
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the psychologist july 2019 annual conference
Honourary Professor Peter Bull hit the headlines
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categories, including attacking the question and personal attacks. Looking at two of Theresa May’s interviews in 2016 Bull found her mean reply rate was 27 per cent; the same rate could be seen in four interviews she gave
in 2017. In 23 sessions of Prime Minister’s Questions in 2016-17 her response rate to Jeremy Corbyn was just 11 per cent. David Cameron, in contrast, answered 21 per cent of Corbyn’s questions in 20 sessions of Prime Minister’s Questions. Margaret Thatcher’s mean reply rate was 39 per cent. Equivocation can be described as overt (for example in explicitly refusing to answer a question), or covert if someone does not acknowledge a question or conceals their evasion completely. Bull said the interesting thing about May’s equivocation is it’s entirely covert. In 43 per cent of her non-replies she entirely ignored the question posed; in 26 per cent of her non-replies she modified the question and answered that instead. Bull said her equivocation could be explained by her extremely difficult position, or perhaps by an obsession over secrets and information control. Some have pointed to May’s small circle of advisors, lack of cabinet and parliamentary consultation over Brexit as evidence for this. ‘If you’re preoccupied with secrecy and control, equivocation makes sense.’ er
Inequality: the Japanese knotweed problem Inequality is a little like Japanese knotweed. It’s destructive, difficult to tackle, and disregarded only by those who haven’t got the problem in their own back yards. As every gardener and estate agent knows, knotweed has long, strong roots that extend far beyond what is visible on the surface; just as the root causes of inequality extend deep into the past and across our world. Pull up one root, and the overall mat of inequality remains frustratingly unchanged. Of course, it’s an ethical
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imperative to try to pull up each and every root of inequality. But what social, economic, and political conditions led to so much of it in the first place? What would it take to create the conditions for inequality not to flourish? We must ask how the systems themselves need to change. We need ground-breaking ideas. One of the speakers rising to this daunting challenge was Dr Deanne Bell (Nottingham Trent University). As part of a panel discussion on how our discipline can respond to the
psychological impact of inequality, she offered an analysis of some of the structural dynamics that have created and perpetuated the problem. Bell argued that mental illness is primarily a consequence of social, not individual, pathology. To improve mental health, therefore, we need to grapple with multiple dimensions of injustice and pain, at both individual and structural levels. Bell highlighted the presentday effects of longstanding patterns of unequal power caused by
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colonialism. These continue to define myriad aspects of the social world, from criminal justice to knowledge production. The cumulative forces of racism, classism, patriarchy, and so on, dehumanise those who are marginalised in society. This happens as people are put into externallylabelled groups – disabled, BAME, transgender – which can negate an individual’s sense of self and make it easier to view certain people or groups as inferior. Ironically, we psychologists usually understand the pain that results from these social processes of dehumanisation as an individual problem. We should respond by decolonising and rehumanising psychology. Bell suggested: ‘decoloniality can hold at once both psychological pain and the conditions of the life world that created that pain. It helps us to stretch intellectually and empathetically.’
• by bringing the same principles of horizontal engagement to policymaking, so that those who are most affected by change become central agents in its planning.
In practice, this can happen in four main ways: • by altering how we research. Those who bear the brunt of inequality should be central to research into it. This calls for participatory methodologies that produce knowledge with people, not simply about or for them. • by decolonising psychology curriculums, so the social determinants of suffering become core elements, not the subjects of occasional guest lectures. This should be accompanied by critical pedagogies in which students and teachers together share their understandings of the world. • by reforming service provision through the use of participatory action research and learning techniques, involving both public and private transformation practices.
The calls to embed matters of inequality in psychological curricula, and for psychologists to engage more politically – both individually and through the BPS – were echoed by Dr Dave Harper (University of East London). He promoted the Psychologists for Social Change network (www.psychchange.org; @psychsocchange) and the BPS Community Psychology Section, who will hold their annual Festival on 13/14 September in Brighton. These groups – and the speakers in this debate – are radically rethinking how psychologists approach inequality, providing hope for the paradigm shifts that might enable us to uproot it once and for all. zs
How can we ensure the NHS has the workforce it needs?
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countries. There’s clear evidence that the system is under pressure, and struggling to think about its needs and provide continuity of care for its patients. This is perhaps not surprising given the current data on the numbers in nursing; add to this the fact that nurses in the UK are relatively less well paid compared to comparator countries, with 4 per cent more than the average earnings in the UK in 2015 versus a typical margin of 14 per cent. It is not just nurses who are suffering from a shortfall – when looking to increase numbers of doctors to make up for existing shortfalls, the sheer length of their highly specialised training is a problem. Another pertinent issue is the UK’s dependence on foreign trained nurses, who comprised 14 per cent of the workforce in 2015 versus the OECD average of just 6 per cent. The UK lacks a convincing domestic supply solution, and the great unknown of Brexit looms large. It’s not all doom and gloom: staff numbers have increased by around 7 per cent. Unfortunately, demand has increased by more than this and there is an estimated shortfall of 100,000 staff against an Getty Images
As one of the UK’s leading experts and House of Lords appointed specialist advisor for the work of the Select Committee on the long-term sustainability of the NHS, Anita Charlesworth CBE spoke on the first morning of the Conference with a data driven and ominous account of the reality facing the NHS workforce. Director of Research and Economics at the Health Foundation, Charlesworth’s presentation focused on the two big groups of NHS staff where consistent data is available: Nursing; and GPs and the Primary Care workforce. Although the data painted a stark picture throughout, the theme of inconsistent or unavailable data raised the question of whether the reality in other pockets of the NHS workforce not represented here might actually be better, or indeed worse, than we anticipate. Using a series of charts and up to date evidence, Charlesworth quickly detailed the UK’s position vs. other Organisation for Economic Co-operation and Development (OECD) countries, showing that the UK has fewer doctors and nurses per head of population than most other OECD
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the psychologist july 2019 annual conference assessment of needs to deliver the care the service has committed to. Perhaps more worryingly, this figure is only based on existing commitments and does not include any improvements to services, leading to an overall shortfall of 250,000 staff between supply and demand versus even a moderate prediction of future needs. Add to this the increase in staff taking early retirement and a low pipeline of new nurses coming through… this could add up to a shortfall of some 350,000 staff. So what is being done? Between 2010-17, ONS figures show that the amount of care delivered by the NHS grew by 23 per cent, while the number of nurses available to deliver that care grew by only 1 per cent. Ministers are announcing extra staff but this does not provide a magic solution, as these roles are highly specialised and require years of investment in training. The shortage only grows when we consider holistic, person-centred care for people who need it on a sustained basis. Charlesworth queried the impact on stability within hospitals and care settings. This churn is particularly present in community health services and mental health services, areas where the depth of relationships between service users and staff are crucial. There is an urgent need for new models of care which take into account the requirement for continuity of care in these areas and the high pressure environments that they present. In addition to looking at training, there is a challenge of retention. The mental health of the NHS workforce is in a poor state: Charlesworth stressed that there are real people behind these issues. The figures for BAME staff are particularly woeful, with increases in reported discrimination combined with a lack of support and lack of opportunities to progress. Work-life balance is reported as a key reason for the droves leaving in later career phases. There are limited options for those who do not wish to work 12 hour shifts into their 60s, and our ageing population has seen an increase in workers with responsibility for the care of their parents, children and grandchildren. Numbers are only one part of the problem – the pace of change within the NHS requires a team model that enables staff to work in a multi-professional way, sharing knowledge of their patients and enabling the multidisciplinary team management of patients across their care lifecycle. Charlesworth’s summary of the evidence was that we don’t have to live with shortages forever – it is possible over the longer term to have enough staff, but the change needs to start today. These complex workforce issues are only increasing in their urgent need for meaningful intervention. Although the bulk of the slides showed the evidence and data, Charlesworth herself presented a series of challenges to psychologists throughout her keynote. Her concluding statement mirrored a trend across the conference for experts in other fields to throw the gauntlet down to psychologists – ‘what are you going to do about this?’ bcmcm Read more about the changing NHS workforce in our upcoming interview with Professor Michael West.
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Frameworks for impact Many academics love the parts of their job that involve knowledge exchange and impact. Fewer are keen on metrics to assess those aspects. Unfortunately, the research excellence framework (REF) and knowledge exchange framework (KEF) require universities to submit case studies providing evidence of these activities, so that they can be assessed. The burden mainly falls on academics, who both write case studies, and assess those of others. The knowledge exchange and impact panel session therefore sought to highlight the purpose of these exercises and the processes involved, while showcasing good examples from psychologists. Professor Dianna Harcourt’s (University of the West of England) presentation of her work promoting body acceptance and appreciation provided an insight into highquality activities that lead to impact. Harcourt’s impressive portfolio includes a board game for children, an intervention for Afghanistan and Iraq veterans, numerous festivals, and a policy change requiring all cleft teams to include a psychologist. In order to demonstrate and evidence impact, Harcourt recommended planning from the outset and seizing all opportunities such as media appearances and joining committees. Dr Helena Mills, head of REF policy at Research England, explained that impact must be underpinned by research. This can be challenging: Harcourt described that it can be difficult to point to a specific piece of research that led to impact, as it often results from more than one study. Another challenge Harcourt found was in the additional work and resources necessary to survey the impact of an activity. Mills highlighted the need for verifiable evidence of both reach and significance, so the additional work is crucial in proving impact. Advocate for knowledge exchange, Dr Suzanne Zeedyk (University of Dundee), aims to help the public understand basic science. She described her work translating
concepts that are meaningful to scientists (such as attachment and coregulation) through different fora, including exhibitions and resources. While Zeedyk’s activities have been hugely influential, her affiliated university has not had any formal recognition, since the structures in place do not fit with this type of work. Dr Hamish McAlpine, head of knowledge exchange data and evidence at Research England, acknowledged the difficulty in reducing these successes into metrics. Nonetheless, McAlpine explained that the KEF is designed to help universities understand their own performance, and to provide information to potential external partners. The KEF is currently in iteration one, so perhaps the future will hold better ways of measuring atypical knowledge exchange activities. For many academics, measuring these activities (or indeed any university activities – there is of course the teaching excellence framework (TEF) too) will never be a worthwhile activity, taking valuable time and resources from the jobs they want to be doing. But it looks like the REF, KEF, and TEF are going nowhere. One small silver lining is that those who do engage in excellent impact and knowledge exchange activities may be better appreciated and respected by their universities – just so long as they have the verifiable evidence to prove it. abb We like to think that The Psychologist can serve as a pathway to impact. If you’ve done the research, tell us about it and we can generally help to put it in front of a large and diverse audience… who knows where that could lead? And of course if you’ve already had the impact and done the work on an impact case study, why not tell us about that?
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Political powers vs Ivory towers Should psychologists be aiming to make the world a better place? Are we over-reaching with this goal? Or in danger of prioritising it to the exclusion of the thrill of pure intellectual curiousity? Are we already making the world a better place – and which successes should be shared and celebrated? What are the core values of psychologists and how do these feed into improving society? These were some of the questions posed by Managing Editor of The Psychologist Dr Jon Sutton at our fringe event at this year’s conference. Ella Rhodes has collected some of the key answers. ‘I see our [the BPS Policy Team] role as a conduit between what psychologists do, in terms of having the expertise and the evidence base, and then being able to make those connections in parliament, to be able to have those conversations. There’s a real disconnect between parliamentarians understanding academia and how we pitch that in three minutes. It’s about being able to say “this is what this could mean to you, it could make a material difference”. The job is messy, it’s about building up connections with our members, knowing who we have to speak to and when, and then building up those external partnerships – because we’re not at the table we should be at the moment.’ ‘In the last month I know that I’ve saved people from going to prison, I have saved people from having horrendous social outcomes… but what I’m not very good at is capturing those kinds of outcomes. That’s where I think the BPS would be massively helpful. Our contracts still focus on activity data, on the fact we’re doing this one to one therapy, when a huge amount of indirect work is not getting captured. We’re missing out on an opportunity to illustrate how we’re preventing harm, and how that then translates into savings for the public purse. I think that’s what we need to steer towards.’
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‘I’m coming at this from quite a different perspective because I’m a teacher of psychology and this year I’ve been in quite a unique position of teaching government and policy as well… It’s been really interesting to look at the young people we’ve been working with and their understanding of government policy and trying to help
them understand how psychology can play a big role in changing society. A lot of the 16- to 17-year-olds we work with come in thinking politics is very boring, very dry and all about money. But we’ve been helping them understand how much policy drives society and how much underpins that for psychological practitioners.’ ‘I do not feel my job is to make the world a better place, that’s an impossible task for any individual. I do feel it’s the role of my professional body, the BPS, to be shouting a bit fucking louder about stuff and taking a position. I think the granular detail of policy is important, and I think it is complicated and difficult, but I think every other professional body takes a stand, has an opinion and voices its expertise. I think the BPS need to become less risk averse, less conservative, and say its piece. This stuff is important and it might make the world better.’ ‘A lot of other professional bodies are quite professional about influencing politicians and they know that politicians have a very short attention span, they know they’re interested in getting voters, they have an event horizon of maximum five years, they want sexy topics that are going to appeal to Daily Mail readers and readers of the Telegraph and are pushing that objective all the time. We’ve done some work with scientists, they are awful. They think by giving more and more data and doing more and more studies and being more and more complicated, and more and more clever, suddenly the politicians are going to listen to them. Guess what? They don’t, they switch off. The BPS needs to be doing that and the fact the Policy Team is being enhanced is a fantastic thing.’ ‘If we want to engage with the public we need to get better at mass media. We continue to allow mass media to misrepresent a lot of the studies in psychology. Consistently you will see a report on a study that says it found one thing but sometimes it has actually found completely the opposite. A lot of policy change and social change comes through mass media and we need to have much better engagement with that. I think part of that is to find some way to recognise the contribution of qualitative science… a lot of people engage far more with an emotional story.’
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the psychologist july 2019 annual conference
The school to prison pipeline
Laura Cariola (University of Edinburgh) presented her linguistic analysis of gender representations of Borderline Personality Disorder in the UK press. Feminine pronouns were more common, with women generally presented as vulnerable victims. Traumatic experiences and abuse were emphasised, along with a pronounced focus on suicide. ‘Living with the label of BPD is difficult’, Cariola concluded, ‘and this coverage increases the marginalisation’.
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competence in teachers, and looking at rehabilitative practices such as restorative justice to keep young children in school to help them through any issues. There are schools in America which have police officers based in them, Alexander said, with little indication schools are safer as a result. Indeed, the American Civil Liberties Union report Cops and No Counsellors found that 1.7 million children in America are in schools with police officers but no counsellors; six million with police but no school psychologists. Addressing such disparities would be a great place to start. Assistant Professor Ediza Garcia (Texas A&M International University) has been working with Latinx college students in improving their mental health literacy. More than 90 per cent of students at Texas AMU in Laredo, on the US-Mexico border, are Latinx and the area has poor coverage for mental health support. Garcia said research has shown that ethnic minority and first generation college students are less likely to seek support for mental health treatment. There are also massive barriers to receiving healthcare in the US, including poverty and cultural and/or language divides. Building mental health literacy can be one way to help college students who may be struggling. An approach developed by Jorm involves teaching people about
common mental health conditions and their symptoms, resources and treatments. Garcia set out with a group of students taking part in a six-week programme, with a week focusing on one of six common mental health problems, and found positive effects of the knowledge the students gained in their willingness to seek help and their knowledge about mental health issues. Getty Images
Clinical and Forensic Psychologist Dr Apryl Alexander, also a Clinical Assistant Professor (University of Denver), kicked off an American Psychological Association symposium with a fascinating – if depressing – look at the ‘school to prison pipeline’ in the USA. Policies and procedures introduced at schools unfairly target children from BAME and marginalised backgrounds, leading to more exclusions and eventually pushing children towards the criminal justice system. Alexander highlighted the criminalisation of normal developmental behaviours such as disobedience, and zero tolerance policies. ‘Two weeks ago in Denver, a seven-year-old was wrestled to the ground and handcuffed,’ Alexander said. Ethnicity is key when looking at this pipeline; while black students make up 24 per cent of the public school population in the USA they account for half of those who are suspended or expelled. Many policies in schools unfairly target black students: Alexander gave the example of some schools not allowing children to wear their hair in braids. She also pointed to research showing that children of colour are viewed negatively from a shockingly early age, with black girls being seen as ‘less innocent’ by the age of five. Ways to break this cycle include prevention, encouraging cultural
Dr Skyler Jackson, a Postdoctoral Fellow (Yale University) explored the experiences of people who have multiple marginalised identities through a daily diary study. He looked at the impact of intersectional experiences in 131 African American LGB people – any positive or negative experiences of events or situations that were related to someone being both black and LGB. Associate Professor Desiree Vega (University of Arizona) took a qualitative look at bilingual (English and Spanish) school psychologists and their experiences of training. er
Your reporters Dr Annie Brookman-Byrne, Deputy Editor Professor Gail Kinman, University of Bedfordshire Beth Clare McManus, Freelancer Ella Rhodes, Journalist Zoe Sanderson University of Bristol Dr Jon Sutton, Managing Editor Find more online, including reports from Madeleine Pownall and Becky Scott. Becky, Beth Clare and Zoe all attended the conference as part of our Voices In Psychology programme. Find their winning entries on our website, and get your thinking caps on for our 2019 question: ‘What makes a Psychologist?’
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the psychologist july 2019 alcohol
‘Everyone has something to add to this conversation’ Within this special collection, a range of articles explore different elements of alcohol use. From the language we use, to digital interventions and considerations from those working on the frontline, this issue brings together authors from different backgrounds to share their insights. Our purpose is to highlight how individual and complex alcohol use and misuse can be. Alcohol consumption impacts everyone differently. To open, we asked each of the lead authors for some personal reflections on the topic.
James Morris Much has been made of the decline in young people’s drinking this century, though some have described 2004 as the point of ‘peak booze’. Having personally been a teenager in the 1990s, when alcopop adverts populated billboards and buying alcohol under-age didn’t seem to be a problem, I embraced ‘binge drinking’ as a key part of my identity. During my time at university I began experiencing physical health problems. This led to me trying to change my drinking. I was shocked by both my own difficulties achieving this, and the particularly disapproving reactions of many ‘friends’. Going through that change led me into working in the alcohol field, as well as eight years of unplanned abstinence during my 20s. During that period I struggled to make sense of what my ‘alcohol problem’ meant, but eventually came to the conclusion that I was confident enough I could drink ‘in moderation’. I felt happy enough as a teetotaller that if it turned out that the ‘sensible’ approach didn’t work, I’d go back to being alcohol-free. Nearly a decade on, I’ve maintained a low-risk drinking pattern and become increasingly interested in how stereotypical ideas of alcohol problems revolve around the belief that abstinence is the only solution. Whilst abstinence may indeed be the best option for the majority of problem drinkers who end up seeking help or treatment, most people who experience alcohol harms do not meet the criteria for dependence and do
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‘recover’ on their own. In our article we explore Adrian Chiles’ BBC documentary as a powerful exploration of how society’s view of alcohol problems is still heavily reliant on a narrow frame of alcohol misuse, and the all too common stereotypes that dominate our conversations. Emma Davies I too was a teenager in the 90s, and my initiation into the world of alcohol involved cheap ciders and alcopops. My friends and I would look forward to the weekend when we would give an older friend, or someone’s brother, the £2 needed to purchase the two cans of Diamond White each that would free us from the constraints of suburban teenage life, if only for a short time. Later on it was ‘Hooch’ or ‘Two Dogs’, as I recall, a lemony, sugary, and all in all much more palatable way of escaping the boredom. At 18, I started to work in pubs and bars, and some of my most long-lasting friendships are those forged behind the bar of The Mitre: a large sports bar by day/ disco by night melting pot, where students got drunk side by side with the locals, generally on amicable terms. From our vantage point behind the pumps we observed a myriad of drunken comportment, from overexuberant student pub crawls (which often ended in us drawing straws to decide whose turn it was to clear away the vomit), to testosterone- and lagerfuelled viewing of sporting grudge matches. If things
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got heated on a weekend night, we would retreat to the kitchen to avoid the airborne pint glasses, while the bouncers broke it up. If they got heated on a weeknight, we became the mediators, encouraging the angered party to agree with our regular pleas; ‘he’s not worth it’ or ‘come and have another drink’. Later, in my first job, our social events were centered on drinking. We would celebrate meeting monthly targets by drinking in the office; we celebrated Thursday and Friday by drinking; we invented ‘Monday night drinking’ both to get some release from the tedium of Monday, and to give us something to do with Tuesday – to suffer together in the shared bonding of a hangover. These experiences, alongside other more personal formative exposure, do, of course, influence my perceptions and interests. Now I find myself in the position of only very recently accepting and embracing that I am an ‘alcohol researcher’ first and foremost. I had planned an escape into physical activity and healthy eating research, but the alcohol drew me back in, with its bubbly promise of fun and fascinating human behaviours. Its ubiquity and seemingly impenetrable role in our lives is part of the draw. The endless contradictions and the stories we tell ourselves to justify our behaviours seem amplified around drinking. Let’s not forget that alcohol is a drug. We drink because we want to change our consciousness, just the same as we do if we decide to take any other drug. The desire to alter our conscious state has always been a part of human experience. That such a powerful and harmful drug is the one sanctioned by society provides another compelling reason to be an ‘alcohol researcher’. Come on in, can we tempt you to join us with one for the road? Claire Melia Alcohol has been present in many aspects throughout my life. I distinctly remember trying my dad’s beer at six or seven years old and being horrified that anyone
Tell us more… We wonder if these stories have made you reflect on your own experiences with alcohol? Given its ubiquity in society, we suspect each reader will have a view, and that you will read and evaluate our articles though that unique personal lens. We hope to have highlighted that this collection is brought to you by authors who have also had different experiences with alcohol. Our main aim within is not to try to categorise, label or influence the ways in which people drink; rather we hope to highlight the complexities of alcohol use and misuse, and raise issues that will provide food for thought (whether you chose to wash that down with a glass of something alcoholic, or a cup of tea). Whatever your position, we hope you find something of interest, and we welcome your comments and feedback. 34
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would drink such a liquid through choice. Whether it was watching my family have a drink at weekends or being allowed small quantities at family occasions, alcohol is something that I’ve been aware of from a young age. Throughout high school alcohol became even more prominent, with frequent house parties where every parent was fully conscious that alcohol was consumed. Yet this was considered a ritual of high school. Learn to drink at home, branch out to drinking at parties, and then go to university and fly free. Throughout university, alcohol was something which held a powerful allure for many students and many of the bonding activities centered around the student’s union and nights out. This is the view that many have of university students. University life is entirely predicated upon alcohol, right? From my experience, this has rarely been the case, particularly after first year. Big nights out became much less frequent. By final year, you were more likely to order a take-away in your pyjamas than to drag yourself to the union bar each night. Fast forward to leaving university, and the weekly routine of drinking cheap alcohol quickly dissipated and was replaced with increased responsibilities. Instead, we swapped clubbing and 3am kebabs for a glass of wine with a film or catch-up. Some people called this growing up, but for many of us it was not a conscious decision. Rather, hangovers were more severe and it became harder to justify losing an entire day to nursing our heads. This is not to say I religiously stick to the unit guidelines at all times, but my friends and I are all much more concerned with finding time to share our company and being able to remember these sacred nights. Maybe it’s a process of maturing, maybe it’s this trend of young people reducing alcohol intake, maybe we simply can’t afford the luxury of drinking each weekend. I’m not sure we’ll ever truly find the answer to such a question, precisely because alcohol is such an individual concept. While many people drink (and many don’t), everyone has their own experience which guides their perceptions and behaviours and this is what makes alcohol such an enigmatic field of research. The in-depth nuances make it an incredibly rich and complex area to work in. Compared to the other authors, my career in alcohol services and research is much younger, but no less interesting. The sheer complexity of the relationship we have with alcohol use as a society is fascinating to me, both personally and as a researcher. I have not once explained my research to a friend, family member, or colleague and not had them relay an anecdote, ask a question, or offer their own perspective. Everyone has something to add to this conversation about alcohol in some way. Alcohol is a unique substance with which our society has an extraordinary relationship and I hope to continue exploring and unravelling this complexity for many years to come.
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the psychologist july 2019 alcohol
Will Haydock I don’t like gambling. No, that’s not quite right. I don’t understand gambling. I don’t mean the policy or regulation, or how odds work (though to be honest, I’m a bit shaky on all of that too). What I mean is that I don’t understand why people do it. I don’t understand the attraction. It leaves me cold. Some might say that makes me one of the worst people to comment on it. If I don’t understand it, how can I pronounce on policy? Interestingly, this isn’t the way I feel about alcohol. People who know me well tend to find it unsurprising that my job involves looking at issues around alcohol. Since I first had an alcoholic drink I’ve enjoyed and been interested in intoxication. I find intoxication – being drunk – pleasurable, and sometimes it’s a welcome relief from the pressures and emotions of everyday life. I also enjoy (or more accurately have learnt to enjoy) alcoholic drinks as tastes and experiences regardless of whether I’m getting drunk. But I sometimes worry that feeling this way, or at least admitting it, is unusual in alcohol policy discussions. People are all too ready to define drinking (or at least drunkenness) as problematic in itself, and suggest that people would be better spending their time and money on more worthwhile, productive pursuits. It’s common to hear people claim that intoxication doesn’t have any value in itself, explaining that they themselves never ‘drink to get drunk’.
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I don’t subscribe to this view. I’m not sure that going for a run or practising yoga is, in itself, any better or worse than going for a drink. One might be better for your health than another, but we can’t assume that health is always people’s top priority, or that it should be. Perhaps the pleasure of drinking outweighs the health benefits of exercise. We can still think about behaviour change, though. There are, of course, occasions when we each get these calculations wrong, and regret our decisions – particularly when the intoxicating and habit-forming characteristics of alcohol come into play. And that perhaps explains my work in relation to alcohol. The services I help commission are designed to support people who have identified that the decisions they’re making aren’t always wise. They can see that alcohol is – wrongly – taking precedence over other things they care about. Coming to this view isn’t always straightforward. People aren’t always ready to change and they don’t always see the harm they are causing to others around them. It’s the job of a good professional to have those conversations that prompt reflection and change – but always based on what that individual wants. Discussions of alcohol policy, like all other issues, need us to have an open mind about why people behave in the ways they do (often quite different to how we might choose to), and what behaviour is desirable, or even simply acceptable.
Post-Qualification Doctoral Post-Qualification Doctoral Programmes Programmes Joint Programmes with Middlesex University Joint Programmes with Middlesex University
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For full details please contact: 08 832 3073 For full details please contact: Sonia Walter, Senior Academic Co-ordinator, on 0208 832 3073 uk Sonia Walter, Senior Academic Co-ordinator, on 0208 832 3073 or email her at sonia.walter@metanoia.ac.uk or email her at sonia.walter@metanoia.ac.uk nd on, W5 2QB Metanoia Institute, 13 North Common Road, Ealing,Road, London, W5 London, 2QB Metanoia Institute, 13 North Common Ealing, W5 2QB egistered Charity 100 www.metanoia.ac.uk Registered Charity10050175 10050175 www.metanoia.ac.uk Registered Charity
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When harmful drinkers are asked about their relationship with alcohol, they are often quick to point out who the ‘real’ problem drinkers are… and it’s not them…
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the psychologist july 2019 alcohol
Challenging the language of alcohol problems James Morris and Claire Melia
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or many people, alcohol use is an integral part of UK culture, deeply embedded in rituals of socialisation and relaxation. Even the UK ‘Government’s Alcohol Strategy’ from 2013 states that alcohol can have a positive impact on wellbeing in terms of sociability and that community pubs are ‘a key part of the fabric of neighbourhoods’. Yet alcohol misuse has a significant cost to the nation, when accounting for the wide-reaching social, economic and individual impacts. Whilst there have been well-reported declines in young people’s drinking over recent years, middle and older aged adults are yet to follow suit. In fact, hospital admissions for alcohol-related liver disease have continued to climb and alcohol consumption is still shifting from bars and pubs to the home. Public Health England (PHE) estimated, in their 2016 evidence review on ‘the public health burden of alcohol’, that there are some 10.6 million adults who drink at levels that could place their health at risk, but that 1.6 million of these adults are classed as ‘harmful’ drinkers and have some level of alcohol dependence. An ongoing challenge has been how to engage and support change within this group. Even amongst the estimated 600,000 people with more established
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alcohol dependency, PHE figures suggest only one in five access treatment for alcohol problems. A number of key barriers for seeking formal help include stigma and a common desire for people to recover on their own. Many people with addictions do indeed recover on their own. For some, this involves simply ‘outgrowing’ problems as they go through life and acquire more responsibilities that drug or alcohol use becomes incompatible with. Others, however, may never recognise their own drinking as problematic and worthy of change. When harmful drinkers are asked about their relationship with alcohol, they are often quick to point out who the ‘real’ problem drinkers are… and it’s certainly not them. This ‘othering’ of problem drinkers is a recognised and common sociological phenomenon which often includes describing ‘alcoholics’ as a distinctly different group from the person seeking to normalise their own drinking. ‘Othering’ tends to rely on a range of readily available public stereotypes about ‘alcoholism’ such as ‘hitting rock-bottom’, drinking in the morning, or a total loss of control of one’s drinking or behaviour. In truth, most alcohol-problems – and even many cases of serious conditions such as liver disease – are not confined to those with severe alcohol dependency. This common practice of pointing to the ‘other’
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days, but compared to a lot of people, I don’t put loads type of drinker relies on binary thinking; people are away’. And here lies the classic escape clause – the either problem drinkers or not. We seek out simplified ever-available option of pointing to other drinkers as explanations of the world around us for a range of the ‘real’ problem drinkers. reasons, with the complex nature of alcohol and By coincidence, last year also saw the publication other such problems often overlooked. Whilst the of a meta-analysis of qualitative explorations tasked disease model of addiction has been credited with a with ‘understanding drinking among midlife men’ move away from the ‘moral model’ of the past, many in the UK, led by research officer Hannah Parke. prominent addiction scientists argue that whilst brain It identified a number of common ways in which change is a feature of addiction, such a pathogenic drinkers justify and explain their brain-centric interpretation is drinking as ‘normal’. These themes scientifically insufficient. Crucially, emerge throughout Drinkers like the shift towards seeing addiction “Chiles’ conversations me, with the use of justifications as a disease has failed to halt the show us that issues and the importance of social global rise of addictive behaviours around alcohol are messy, identity particularly apparent. and associated stigma. ‘I’m not someone who fights, or The simplified public narrative complex and individual” gets involved with the wrong around drinking was explored people when I’m drinking’, Chiles last year in a BBC documentary reassures the viewer. However, he continues to say that featuring Adrian Chiles, Drinkers like me. The the programme is not about people ‘who drink sherry programme was applauded by The Telegraph for its in the morning or wake up in shop doorways… this is ‘sobering, fascinating and disarmingly honest look about nice, regular drinking, and the damage quietly at social drinking’ in which Chiles explored whether being done to ourselves and society, by drinkers like his relationship with alcohol was indeed a ‘problem’. me.’ The show was predicated on disentangling the false And so the journey begins. Chiles is filmed in binary of alcoholism. It starts with Chiles stating ‘My the pub on a match day with his ‘cronies’. It’s still name’s Adrian Chiles, and I’m not an alcoholic… at least, I don’t think I am’. He continues, ‘I do drink most not midday, and so Chiles asks the group whether
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the psychologist july 2019 alcohol
the ease with which the pints are going down begs the question ‘...is this a slippery slope? Am I going to be one of those people in Wetherspoons at ten in the morning?’. Fellow football fan Kev quickly offers justifications for the group’s drinking, stating ‘I do know lads who will start drinking Sambucas especially, as soon as they jump on the train. So, there’s drinking and there’s drinking.’ Chiles, however, is not coming along for the ride this time. ‘Kev, I know some genuine alcoholics, they all say words to that effect – “there’s drinking, and there’s drinking – and guess what, I’m on the right side of the line… they’re drinking sambuca, they’re drinking more than me and they stay up later than me, their kind of drinking is bad… mine’s fine, ‘cos I’ve made my own little rules”.’ Kev’s retort displays the rationale of ‘control’ – a theme also identified in the systematic review. ‘Well I know my limit. Right? Some people don’t.’ Next Chiles ponders to the camera whether the classic alcoholic stereotypes are really representative of problem drinkers. ‘Just because you’re not any of those things, doesn’t mean you’re not alcohol dependent, or have got some kind of dependency issue with alcohol.’ Later Chiles meets Professor David Nutt, to ask how much more than the 14 units a week guideline one needs to be drinking ‘to be considered an alcoholic’. Nutt offers a reality check. ‘People say “well I’m not drinking very cheap cider, and I’m not sleeping in the gutter, so I’m alright”. And that’s not true. We know a third of people coming into the liver unit with alcohol-related liver damage, do not meet the criteria for alcoholism.’ Others attempt to offer familiar narratives. Sarah admits to ‘not really having a stopping point’ when binging, but says she it would never lead her to having a problem – she has no interest in morning drinking and is ‘not a vommer’. Chiles also meets Mark, who he identifies as just like himself. Mark wants to highlight why his drinking isn’t a cause for concern: ‘I don’t wake up in the morning thinking right…’, but again Chiles is not here to be complicit. He challenges him; ‘that’s the fallacy I tell myself, I don’t want to drink anything in the morning… but that doesn’t mean that I’m not addicted to alcohol in some sense, which I am. I’m sure I am, and you are!?’. Mark pauses briefly, then half concedes, ‘to a degree, we’re addicted to it, without being alcoholics’. Later on Chiles meets people who have actively changed their drinking. Charlie describes a ‘rock bottom’ where she was drinking three bottles of wine a night. The anxiety and other problems led her to seek help, and now she only drinks a bottle of wine a week. Chiles asks comedian and friend Frank Skinner, a self-
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James Morris is Director of the Alcohol Academy james@ alcoholacademy. net
identified ‘recovering alcoholic’, whether he needs to quit. Skinner admits his social life has ‘never been the same’ since giving up alcohol, but challenges Chiles to give up for three months. However Skinner reassures Chiles that if he’s one of those people who can ‘just Claire Melia keep this side of the dark side’ he is a postgraduate shouldn’t stop indefinitely because student at Keele drinking ‘can be so brilliant’. University Whilst just a snapshot of the c.r.melia@ estimated 1.6 million harmful keele.ac.uk drinkers, Chiles engages with a variety of perspectives; whether they are unabashed drinkers, reconsidering, or have already made changes to their consumption. Through these encounters, themes reliably found in qualitative drinking accounts are repeatedly described, particularly what may be commonly described as ‘denial’. Those not yet wishing to change heavy drinking habits justify them by defining problem drinkers as ‘others’ – those who drink more than them, can’t control their behaviour, or need to drink in the mornings. As such, they place themselves on the ‘safe side’ of an invented dividing line. The show’s success may be best judged by its apparent stimulation of discussions and reflections about what alcohol problems really are, particularly given there is no ‘one size fits all’. Chiles’ conversations show us that issues around alcohol use are messy, complex and individual, and to really unpick this requires more nuance than common binary ‘alcoholic’ narratives. Not all viewers may agree, and some may even feel Chiles’ may be irresponsibly promoting ‘moderation’ to drinkers who they feel just need to stop. Research, though, has shown that both addiction and recovery comes in many forms, even if public perceptions are more singular (see the 2017 study led by Kiran Pienaar – tinyurl.com/y82q34yl). More nuance and honesty The concept of alcoholism can be important for some drinkers seeking recovery from problems. But from a public health perspective, challenging this binary thinking should be seen as a potentially valuable change. Notably, shifting understandings towards a more continuum approach can help to break down the stigma of alcohol problems that stops many drinkers from contemplating change. We could all consider our own drinking with a little more nuance and honesty. There would be advantages to resisting easy but problematic simplifications such as ‘alcoholics’ or ‘addicts’ in our conversations, and instead recognising that people and the problems they experience are more complex.
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Michael Kelleher ‘Your number one problem substance is alcohol’ Dr Michael Kelleher is a consultant addictions psychiatrist at the South London and Maudsley NHS Trust. He is the Clinical Lead for the Lambeth Addictions consortium, an innovative and effective collaboration between the NHS, Addaction, Phoenix, Blenheim and the local authority. James Morris spoke to him (with thanks to Claire Melia for transcribing and editing).
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With regards to the merging of substance misuse services. If we’re able to provide opioid-dependent services, are there differences in the way that people patients with same-day scripts of methadone who turn with alcohol-specific problems tend to seek or up, why can’t we provide the alcohol-dependent with respond to professional help? same-day assessments and initial treatment of alcohol One of the problems you’ve got with substances as in the same way? We should catch people at their point a whole is the treatment budget is limited. There of motivation, when people have motivation to come will always be more demand than you can meet. You to a treatment service, because motivation fluctuates. could end up cutting your addiction services multiple I am not a great fan of endless assessments different ways, so you could have a heroin-only before an alcohol-dependent patient receives some service, then you could have a poly-drug and alcoholintervention. I’m not a great believer in this idea of using service, a Novel Psychoactive delaying patients for long periods Substances (NPS) service, etc and until they are assessed as being “…you need to be able to ready for detox. It is difficult to you could have an alcohol-only service. Dividing services in so know what ‘ready’ means. It can develop services which many different ways would make be hard if you’re drinking 10 can give alcohol equal many unsustainable with restricted pints a day to show appropriate status and recognise that engagement. So what we’re trying opening hours. I don’t think the money is there in the system to to do is move to a point where you you need a pathway that have special alcohol services, but detox people as quickly as you can address alcohol” we need to recognise the alcoholpossibly can, if that’s what they dependent patients as having request and they’re motivated. different and equal needs. We should endeavour to support What is clear is that the approach needs to be ongoing recovery and address underlying, social, nuanced. You cannot approach the treatment of psychological and physical health issues. alcohol dependence with a heroin hat. Just like you can’t approach NPS with a heroin hat. You can’t take So it’s not a problem of being able to cater for a single model to fit all substance treatments. Nor can the needs of alcohol-dependent patients within a you allow opioid targets to dominate the service to substance misuse service, perhaps it’s about getting the exclusion of alcohol-dependent people, because people to services when they’re ready and feel able to in every local area, when it comes to population-wide do so. use, your number one problem substance is alcohol. I think you can even move beyond that. What’s nice Therefore, you need to be able to develop services is to have a multiplicity of entry points into your which can give alcohol equal status and recognise that treatment system. So people can self-present here you need a pathway that can address alcohol. but also as we work with almost every GP practice in Lambeth, at their GP surgery. So if they don’t want to How does that pathway begin? come to Brixton they can also see the addiction worker In Lambeth the vast bulk of people self-present to in the GP surgery. Furthermore by linking into hospital
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the psychologist july 2019 alcohol
alcohol care teams, if they detox someone in hospital, they can transfer their care to our recovery space. I think you need to offer this range of options, because stigma runs many ways. There are alcohol clients who don’t want to come to a drugs service and drug clients who don’t want to be characterised as alcoholics. It is not that one setting is better than another; it is that individuals prefer different settings to meet their unique needs.
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You’ve worked a lot with policy roles and commissioners. Sidestepping the obvious issues of budgets, are there any other key issues that you think alcohol treatment providers should be thinking about? I’m not sure it’s right to sidestep the issue of cuts. We can’t get away from the fact that addiction services across England have taken significant cuts. This isn’t the fault of local authorities; this is a reduction in
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funding from the centre which slips through because addictions and indeed community sexual health are no longer part of the NHS. I am not sure this point is understood. I think if you look at the drop in numbers in alcohol treatment, my personal view is that you can’t separate it from cuts to services. I also think there is a definite problem that we’ve been cut off from the commissioning and planning of the NHS in its broader sense. For example, that we’ve been cut off in a way from the commissioning of liver services, primary care, pharmacies and mental health. At some point this needs to be addressed. It is good that so many different options for treatment entry are available but there are also people who don’t make it to any of these entry points. Complexity dwells in many domains. It is not just those who repeatedly present to acute hospitals. For example, if you’re drinking yourself to death in a tower block somewhere and you’re not going to hospital because you don’t want to waste A&E’s time. Or, you’re someone who binge drinks to blacking out, but you’ve got two children in your care. These are different kinds of complexity. So we need to recognise the breadth of complexity when it comes to alcohol, and it would be lovely to have the resources to work more extensively with these groups who do not make it to services anywhere. And detox is a big part of that. Yes. We have a real crisis in England with the provision of inpatient detox. Funding reductions have meant that there are no longer 24-hour medically staffed detoxification units in many parts of the country; indeed there are none within the M25. This is worrying because we know alcohol is the leading cause of death in adults under 50 mainly associated with its physical and psychiatric co-morbidities. We are lucky in Lambeth that St Thomas’ Hospital and our local CCG have agreed for us to detoxify our most physically complex patients in their Medical Assessment Unit. I think we need to acknowledge that many people drink alcohol because they’re anxious or depressed. Alcohol is both a marvellous elevator in mood and a suppressor of anxiety but only in the short term; as we all know, over time it makes these problems worse. Unfortunately some IAPT services exclude patients that use or have used alcohol until they are many months abstinent. This is contrary to positive practice guidelines that the NTA brought out in 2013. There needs to be an effort to make sure all IAPT services and addiction services are linked. So if people get detoxed they shouldn’t have to wait an arbitrary length of time to be sober before they can have psychological therapy. They should be able to flow into an anxiety or depression programme straight away once a detox is completed. I really think that is one of the crucial links we need to get much better at. 42
Taking a bit of a step back and thinking more broadly about alcohol misuse across society and people who
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don’t engage with treatment services, what would you like to see done in that particular area? Lambeth, a borough of 300,000 people, has something like 1,700 places where you can buy alcohol. It’s available 24 hours a day. You can get the pizza company to deliver alcohol to your door. It’s too available, it’s too easy. We know there is a link between availability and levels of use. There’s a licensing issue which needs to be addressed. There is also a strong evidence base about Minimum Unit Pricing (MUP). Alcohol is too cheap. This is not to be puritanical, but societies need to find the correct balance between availability of alcohol and the harms caused by such availability. In England my view is that we have made it too easy and cheap to buy. There’s an important issue of autonomy isn’t there, that probably applies across the spectrum of alcohol misuse, whether someone is thinking about changing because they want to reduce feeling sluggish in the morning, versus someone who has these complex needs. Over my time working in addiction with alcoholdependent patients I’ve come to the conclusion that I’ve two overarching tasks. Firstly, trying to keep people alive by harm-minimising around their alcohol use. So for example, if they are suicidal they need an urgent psychiatric intervention. If they have cirrhosis treat their liver disease. If they are not eating provide vitamin supplementation to stop them getting Wernicke’s and Korsakoff’s. If they smoke, and more than half do, address nicotine dependence. Secondly, supporting them to understand their autonomy and their internal capacity for change. I’ve never seen anyone change who doesn’t understand their own agency. An excessively biological disease model of addiction can get in the way if the alcoholdependent individual views their problems as a disease which can be cured by a pill or a therapy rather than one they can help address. I think what I find troubling about an excessively biological model of addiction is that we risk reducing people’s resilience and ability to understand their own ability to change. We then fail to recognise the wider social setting where they exist. Of course our support and treatment needs to be available and offered. Of course we should recognise the biological drivers of alcohol dependence. But it needs to be as a partnership where both the patient and professional collaborate and we encourage patients to understand their agency. When alcohol-dependent patients make that change it’s rarely an epiphany, rather a more gradual process, but it is amazing when you watch people making that transformation. Indeed many of the people I work with are in recovery from alcohol dependence. To steal a phrase from another field, they often appear ‘better than well’. They understand something about their ability to control their drives, their desires and how their drives and desires have damaged them.
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the psychologist july 2019 alcohol
Community Psychology Festival 13–14 September 2019, Grand Parade Building, Brighton
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Conference theme: Critical optimism in an age of austerity.
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An inclusive forum to come together to inspire and challenge.
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Workshops, debates, films, art installations and other formats.
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Let’s give psychology back to those that need it the most.
To register visit www.bps.org.uk/5thCommFest-Sept19
@communitypsych2
Bring passion for change, not welly boots
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Finding moderation online Emma L. Davies, Zarnie Khadjesari, Olga Perski and Claire Garnett on digital interventions to reduce alcohol consumption. Are you thinking about changing your drinking habits? The Global Drug Survey suggests that over a third of drinkers in the UK would like to reduce their drinking in the next year (Davies et al., 2017). Furthermore, Public Health England suggest that around one in five people in the UK are drinking above the low-risk guidelines of 14 units per week, and should probably be thinking about cutting down. Could an app or a website help?
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he highs and lows of drinking are well known. Alcohol can enhance social interactions by promoting bonding, and it can provide space to unwind from the pressures of work. However, excessive alcohol consumption is associated with increased health risks, such as cancer and liver disease, and with elevated levels of depression and anxiety. In 2014, the World Health Organization set a target of a 10 per cent relative reduction in harmful alcohol use by 2025. To meet this target in a time of reduced spending on public health around the world, it is clear that we need both effective and cost-effective interventions that are widely accessible. Evidence suggests that brief face-to-face interventions, delivered by healthcare professionals, can be effective in reducing alcohol consumption in some groups – but less than 10 per cent of excessive drinkers receive these (Brown et al., 2016). Recently, there has been a shift in focus to digital interventions for alcohol reduction, because of their potential to reach larger numbers of people at low cost per additional user. There are many examples of these digital interventions for alcohol reduction freely available online. No silver bullet Digital alcohol interventions were not envisaged as a ‘silver bullet’ to replace traditional interventions delivered by healthcare professionals; rather, they are viewed as an adjunct to care, with their origins in bibliotherapy. There are fundamental features of face-to-face interventions that cannot easily be transferred to a website or app, particularly Carl Rogers’ core conditions of genuineness, unconditional
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the psychologist july 2019 alcohol
engagement. For example, a user might have opened a positive regard, and empathy. However, some of the webpage but not necessarily read through the content. ‘active ingredients’ (also known as ‘behaviour change Hence, engagement is thought to occur at different techniques’) that form the content of the intervention levels of intensity each time a user interacts with a are well suited to digital format, such as screening for excessive alcohol consumption, personalised feedback, digital intervention and can be assessed repeatedly over the course of the treatment period (Perski et al., 2017). goal-setting and self-monitoring of one’s drinking Research shows that many different factors promote behaviours. There have been attempts to convey or detract from engagement with digital interventions the therapeutic alliance online, for example, via an for alcohol reduction. At the point of uptake, users extensive behaviour change website called Down Your tend to select apps that are immediately appealing and Drink (www.downyourdrink.org.uk), with interactive easy to use, have been rated highly by other users and exercises and a tone that encourages reflection and have realistic and relevant titles (Perski et al., 2017). individual choice (Linke et al., 2008). The latest Once an app or website has been selected, engagement research evidence suggests that digital interventions tends to be greater in females, older people, those with where a healthcare professional facilitates access are higher education (i.e. post-16 qualifications), higher more effective at reducing alcohol consumption than baseline levels of motivation to change and lower stand-alone digital interventions (Riper et al., 2018). baseline levels of alcohol consumption (Radtke et al., There are also active advantages to delivering 2017). digital interventions online or via an app, in their Qualitative studies have highlighted that entirety. The stigma and embarrassment associated potential users are more willing to engage with digital with seeking help for an alcohol problem face-to-face interventions that support their motivation to reduce is an important factor that delays or prevents help alcohol (e.g. through encouragement or providing a seeking. Drinking alcohol excessively is sometimes choice of what components to use). They are also more perceived as synonymous with dependent drinking, drawn to apps that make them feel that the content and the first obvious treatment option may be and design are relevant to them and what they are Alcoholics Anonymous. Where do people go if they hoping to achieve (Perski et al., 2018; Postel et al., want to moderate rather than abstain from drinking? 2011). For example, a study testing the usability of Those looking online can seek support at a much the Drink Less app (https://drinklessalcohol.com), earlier stage. ‘E-help seekers’ who accessed the Down both initially and after two weeks of use, found that Your Drink website reported a variety of reasons why users were unlikely to engage with an online intervention was of help app components that they did not to them; for example, it helped “Where do people go if see an obvious benefit of, and that them think about their drinking users liked being rewarded for their and provided reassurance that they want to moderate achievements (Crane et al., 2017). they were not alone, it helped rather than abstain from This has implications for the design them recognise that their drinking drinking?” of digital interventions – those was a problem, and it provided that use elements of tailoring and support and techniques to cut positive reinforcement may stand a down and monitor their drinking. better chance at engaging their users. It’s much like a Further, these ‘e-help seekers’ wanted support that therapist would tailor interactions with different clients was suited to their level of need, that did not interfere to suit their individual reasoning styles. with their everyday lives, and that was personal to Intervention developers have also explored the them (Khadjesari et al., 2015) – all of which digital use of humour as a means of engaging young people interventions can provide. with digital interventions. Rather than receiving advice about their specific drinking habits, users of the OneTooMany app (www.onetoomany.co) answer User engagement Given that this support is delivered outside of a face-to- 20 questions relating to incidents that might occur as a result of alcohol consumption. Many of these face setting, some form of ‘engagement’ with a digital involved potentially embarrassing situations that intervention is necessary for it to help people change. young drinkers might regret. For example, questions However, engagement with digital interventions tends included whether users have ‘had embarrassing to be low, with many users dropping out during the pictures or videos of you taken and posted on Twitter first week of the treatment period (Eysenbach, 2005). Psychologists have typically thought of engagement or Facebook etc when you’ve been drinking’, as well as asking whether users have ‘had to have your friends in this context as website or app usage, as this may take care of you when you have been drinking’. indicate a user’s exposure to critical intervention Responses to these questions generated an Alcohol content. However, research from the digital gaming Related Social Embarrassment (ARSE) score, out of a and human-computer interaction fields show that total of 40. These scores were broken down into four users’ subjective experience (such as whether they groups, each category being given a label and offered pay attention to the digital intervention’s content feedback on the type of drinker that score might relate and are interested in it) are also important aspects of
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to, and the risks and consequences associated with it. Research with students and young people suggests that this humorous approach had the potential to be very engaging (Davies et al., 2017). However, there was also evidence that some of the embarrassing scenarios discussed in the app might actually confer status on young people; clearly this is an area for further exploration.
Key sources Davies, E.L., Conroy, D., Winstock, A.R. & Ferris, J.A. (2017). Motivations for reducing alcohol consumption. Addictive Behaviors, 75, 40-46. Davies, E.L., Law, C., Hennelly, S.E. & Winstock, A.R. (2017). Acceptability of targeting social embarrassment in a digital intervention to reduce student alcohol consumption. Digital Health, 3, 2055207617733405. Davies, E.L., Maier, L.J., Winstock, A.R. & Ferris, J.A. (2019). Intention to reduce drinking alcohol and preferred sources of support for help. Journal of Substance Abuse Treatment, 99, 80-87. Garnett, C., Crane, D., West, R., et al. (2018). The development of Drink Less: An alcohol reduction smartphone app for excessive drinkers. Transl Behav Med, iby043-iby043. Kaner, E.F.S., Beyer, F.R., Garnett, C., et al. (2017). Personalised digital interventions for reducing hazardous and harmful alcohol consumption in community-dwelling populations. Cochrane Database Syst Rev, 9, Cd011479. Khadjesari, Z., Stevenson, F., Godfrey, C., & Murray, E. (2015). Negotiating the ‘grey area between normal social drinking and being a smelly tramp’: A qualitative study of people searching for help online to reduce their drinking. Health Expectations, 18(6), 2011-2020. Linke, S., McCambridge, J., Khadjesari, Z., et al. (2008). Development of a psychologically enhanced interactive online intervention for hazardous drinking. Alcohol Alcohol, 43(6), 669-674. Perski, O., Baretta, D., Blandford, A., et al. (2018). Engagement features judged by excessive drinkers as most important to include in smartphone applications for alcohol reduction. Digital Health, 4, 2055207618785841. Perski, O., Blandford, A., West, R. & Michie, S. (2017). Conceptualising engagement with digital behaviour change interventions. Transl Behav Med, 7(2), 254-267. Sinclair, J.M.A., Chambers, S., & Manson, C. (2017). Internet support for dealing with problematic alcohol use. Alcohol Alcohol, 52(2), 220-226.
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Full list available in online/app version.
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Who might use digital interventions? Seeking support online might not be for everyone. For example, a study of student drinkers identified that they preferred informal sources of support, such as talking to friends, over online tools (Buscemi et al., 2010). Other research suggests that the anonymity offered by online tools may be more appealing for some groups of harmful drinkers, who may be concerned about the stigma associated with helpseeking for alcohol problems (Khadjesari et al., 2015). Although digital interventions may not be as easily accessible to some populations such as the homeless, those in prison, or the elderly, digital interventions particularly targeting these populations are beginning to emerge. For example, the computer-assisted ‘Breaking Free Online’ programme was developed to provide continuity of substance misuse care for prisoners regardless of their location (e.g. transferral to a different prison or release into the community) and has demonstrated initial feasibility and acceptability (Elison et al., 2016). However, more work is needed to identify those who may benefit from digital interventions, and those who may be excluded. In addition, research shows that there are other sociodemographic and regional factors that may influence user preferences for online tools. Research from the Global Drug Survey in 2017 explored more than 80,000 people’s preferences for different sources of support to help them reduce their drinking (Davies et al., 2019). Those who expressed an interest in getting help to reduce their drinking were asked to select their preferred source of support from the following options: self-
Digital interventions can deliver tailored support to users
help tool (online or via app); counselling via email; counselling via phone; counselling via Skype/live video; counselling at a GP/ family doctor; counselling or therapy at a specialist doctor; alternative therapy. About a third said they wanted to drink less in the next year, but only a small proportion of these individuals (7.6 per cent) wanted help to cut down. Although a high proportion of these people (38 per cent) said they would prefer an online tool, there were some important differences in the characteristics of people who selected this option when compared to those who said they preferred to receive face-to-face support from a specialist doctor. People with higher scores on the Alcohol Use Disorders Identification Test (i.e. heavier and dependent drinkers), those who were not educated to degree level, and those who were on medication for a mental health condition said they would prefer the support of a specialist to reduce their drinking. On the other hand, lower risk drinkers, those educated to degree level, and people who were not on medication for a mental health condition preferred online tools for support. Dependent drinkers with an existing mental health condition may be vulnerable to further harms, and this may be better helped by face-to-face counselling. Access to good quality support which is available at the point of need is essential to help this group of drinkers. It is therefore important that digital interventions that offer screening and brief advice also support referral of high risk drinkers into specialist treatment services – at present, only a very small proportion of those with alcohol use disorders access any treatment whatsoever. Hence, a growth in high quality digital tools could be a way of widening access to help. Health inequalities are a particular concern with regards to alcohol consumption, as the most deprived groups drink the least but suffer the most alcohol-related harm (Bellis et al., 2016). If digital interventions are going to play a major role in providing alcohol reduction support, then they need to be equally acceptable and effective across the social spectrum. However, a ‘digital divide’ does exist, with people of a higher socioeconomic status still more likely to own a smartphone. A recent study found that users of the smartphone app ‘Drinks Meter’ were
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the psychologist july 2019 alcohol
of Club Soda is to normalise non-drinking in social settings, and to this end, they champion innovation in the production of non-alcoholic beverages, and run ‘Mindful Drinking’ Festivals Are digital interventions around the UK. Members of both effective? communities can access an array Digital interventions have the Zarnie Khadjesari of online resources such as blogs, potential to help disadvantaged is a Senior Lecturer in Health chatrooms and webinars and share groups, when they are designed Promotion, School of Health their experiences. Testimonials with appropriate user input. The Sciences, University of East Anglia on the Soberistas website attest to Drink Less app took this approach, the many positive experiences of in order to maximise the appeal Olga Perski people who engage in their online and usability of the app across is a Research Associate in the community, and academic research the social spectrum (Garnett et Department of Behavioural Science suggests that this platform provides al., 2018). When this approach to and Health at UCL (Tobacco and a supportive environment which development and usability testing Alcohol Research Group) enables people to stop drinking was taken for a smoking cessation (Chambers et al., 2017; Sinclair et web-app, it was found to be Claire Garnett al., 2017). effective across the social spectrum is a Research Associate in the There is no one-size-fits-all (Brown et al., 2012). Department of Behavioural Science intervention approach to reducing Until recently there was little and Health at UCL (Tobacco and alcohol consumption; a suite of evidence as to whether digital Alcohol Research Group) digital interventions, bibliotherapy, interventions were actually a stepped care approach to faceeffective at reducing alcohol to-face intervention, and policy consumption. A systematic review, led changes are likely to be needed to achieve WHO’s by Eileen Kaner and published in 2017, aimed to find target of a 10 per cent relative reduction in excessive out whether digital interventions were more effective alcohol consumption by 2025. Although it is clear at reducing alcohol consumption compared with some form of control group (these included assessment only, from the evidence that digital interventions for alcohol reduction can confer a range of benefits to users and waiting list control groups and standard health-related the healthcare system at large, conducting research in information). The review included 41 randomised this field is complex. While digital interventions can controlled trials that evaluated the effectiveness of deliver tailored support to users as and when needed a digital intervention for reducing hazardous or and reduce stigma associated with help-seeking in harmful alcohol consumption. The majority of digital person, they require active engagement on the part of interventions that were eligible for inclusion in the user (which may lead to early drop-outs) and may this review were web-based, though some involved be particularly burdensome for heavy drinkers or users computer programs and one app-based intervention with mental health conditions. was included. The most frequently used ‘active To further our understanding of the potential ingredients’ were: i) feedback on drinking behaviour; benefits of digital interventions it is therefore ii) social comparison; iii) information about the social important to develop or refine existing tools so and environmental consequences; iv) feedback on the that they engage their intended target audience and outcomes of their behaviour, and v) social support. signpost higher risk drinkers to appropriate sources Participants using a digital intervention drank 22.8g of support. We must be cautious of transitioning to (almost three units) of alcohol a week less than those a norm of ‘technological utopianism’, which risks receiving a control. It’s tentative support for the role alienating certain groups, or trivialising issues that that digital alcohol interventions can play in helping require deeper investment and human interaction. people to reduce hazardous or harmful alcohol At present, the field of digital interventions consumption. continues to expand with many options now freely available through various types of technology. It is vitally important that digital interventions are Online communities evaluated robustly and pragmatically to continue to Alongside the digital tools discussed so far, most of inform the evidence on the effectiveness of digital which have been developed by academics, there are interventions to reduce alcohol consumption. If you a number of online communities that have grown are thinking of reducing your drinking, you may find outside of academic research. Two examples are that some kind of digital tool is useful, particularly in ‘Soberistas’ and ‘Club Soda’, both of which provide tracking your alcohol intake. However, you don’t have support for people who want to stop drinking alcohol. to rely on digital tools – speak to your GP if you feel Club Soda also offers support to those who wish to you need further support. moderate their drinking. Another important goal from a higher social grade than the general population of drinkers in the UK (Garnett et al., 2017).
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Emma Davies is a Senior Lecturer in Psychology, Faculty of Health and Life Sciences, Oxford Brookes University edavies@brookes.ac.uk
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A threadbare patchwork of support
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Will Haydock with a report from the bureaucratic frontline
s a local authority ‘commissioner’ of substance misuse treatment services in Dorset, my role is to award funding from the central government public health grant to organisations in order to deliver treatment services, and ensure they do what they’ve promised to do in return. In our case, we have a mixture of NHS organisations and charities delivering support locally, linking with GPs, hospitals and other community healthcare services. I don’t work directly with patients, clients or service users. The frontline of my work is in committees and board meetings. I want to reflect on these experiences and think about how well this patchwork of services is functioning. First, I’ll outline what services are trying to do, and explain some of the history. Then I want to discuss the two huge interlinking challenges that local councils and the NHS are facing right now. One of these is, of course, the financial challenge of austerity. However, it’s also important that we talk about a second, perhaps more abstract, issue: how our response to these conditions has been weakened by the structures and cultures of the organisations that are responsible for providing support to people with alcohol-related problems. The problem, I suggest, is an adversarial culture where people and organisations seem to pit themselves against each other. Alcohol treatment is an area of healthcare that has been at the forefront of market reforms, and where ideological battles over the nature of addiction continue to be fought, so while it might be an outlier it could also be seen as a bellwether. This isn’t a criticism of provider organisations, competing for scarce resources; it’s more about policymakers and commissioners who have created, accepted and perpetuated damaging structures and cultures that have shaped the whole sector. Given that I don’t have much good news to report from my experiences on the frontline of public sector bureaucracy, this might seem like a portent of doom for the wider healthcare sector. However, I’m confident I can do more to challenge this tendency to competition in my own work, and I hope this article can serve as both a warning and encouragement for people working
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in different roles and fields across health and social care. How well do we treat alcohol issues? In treatment discourses, we often talk about ‘recovery capital’, meaning the stock of factors that support people to improve their situation (Best & Laudet, 2010; links to references are in the online version). This refers to having some kind of financial safety net, stable accommodation, good health, employment, and so on – not to mention the importance of being surrounded by supportive, like-minded people. What seems like an ‘alcohol’ problem, therefore, is often best addressed through interventions that aren’t specifically about alcohol, boosting people’s wider ‘recovery capital’. It’s not so surprising then that a lot of organisations are potentially involved in alcohol treatment, and it can look a bit messy. Maybe a patchwork arrangement is perfectly sensible – or at least unavoidable – given the challenges we face in defining the problem. So how well are our messy services dealing with this inevitably messy set of problems? The usual comparison is with ‘drug’ treatment services – i.e. services for people who have run into problems using illegal substances, typically opiates (like heroin) or crack. Services in England engage a far higher proportion of opiate users in treatment – about 55 per cent – than we manage with alcohol, where specialist services saw about 22 per cent of dependent drinkers in 2017-18 (Public Health England, 2017a, b, 2018). However, when services do engage dependent drinkers, they’re more likely to get a successful outcome than opiate users (Public Health England, 2018). This suggests that the issue isn’t one of quality or ability on the part of services and staff; it’s about engaging more people and having the resources to help them in the same way if they do come. For some people, this difference between alcohol and other drugs might seem counterintuitive.
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the psychologist july 2019 alcohol
Perhaps more than any area of healthcare, treatment for alcoholrelated issues can involve myriad funders and providers. How is this network of provision working, and what are the lessons for other areas of health and social care? Campaigners often note that making certain drugs illegal has increased the stigma around their use, so people are less likely to seek out help (McCulloch, 2017). Equally, though, it’s possible to argue that the legal status of alcohol, and the fact that even heavy drinking can be constructed as ‘normal’, means it’s harder for people to accept and reveal they have a problem (Morris, 2017). Tough on the causes of crime But this difference in numbers isn’t just a consequence of one substance being legal and more deeply embedded in our society. It’s also the result of conscious policy decisions by successive governments to prioritise addressing use of illegal drugs. The funding allocated to substance misuse treatment in the 2000s was justified in terms of the New Labour pledge to be ‘tough on the causes of crime’. In that period, heroin was seen as a key driver of acquisitive crime, and therefore treatment was designed to reduce crime for the good of society as much as promoting recovery for the individuals concerned (Seddon et al., 2008). The funding, therefore, was for drug treatment (specifically heroin and crack), not alcohol issues – illustrated by the fact that the local partnerships set up to oversee funding plans were called Drug Action Teams (DATs). It was only much later that DATs
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became DAATs, with the addition of ‘Alcohol’ to the acronym, but even then there was no accompanying increase in funding. Alcohol treatment was largely seen as the duty of the NHS, despite the fact that prescribing for detoxification was noticeably absent from the new 2003 contract drawn up for primary care GPs. It seemed that local alcohol policy discussions were less about treatment and more about prevention and harm reduction, with an emphasis on the night-time economy, licensing and brief interventions all seen as legitimate concerns of local public health teams – but without any significant funding attached. Alcohol, as a more commonly used substance that was known to cause widespread harm across the population, always felt like more of a public (or population) health issue, while ‘drug’ use was seen as a largely criminal matter. This mattered because, even after DATs became DAATs, there was a sense that alcohol treatment remained the ‘poor relation’ of drug treatment (Drink and Drug News, 2013), and certainly less was spent on this specific area of substance misuse treatment. In the first year after substance misuse responsibilities (and budgets) moved to local authorities under new public health teams, local authority data suggested that almost £600m was spent on drug treatment for adults, compared to about £200m on alcohol treatment (HM Government, 2015). Some commentators, and even parts of government, hoped that the budget might now be rebalanced to address alcohol problems more
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adequately. The Government strategy ‘Putting Full Recovery First’, lamented that ‘for too long alcohol has been a neglected and isolated partner in the treatment system’ and promised that the public health reforms would ‘mean that alcohol misuse is finally given the treatment attention its serious impact merits’ (HM Government, 2012: 12, 4). However, rebalancing the budgets in this way would have meant reducing the funding for some other function unless the overall funding pot was being increased. Instead, despite occasional specific funding opportunities, overall public health budgets are being reduced year on year, and substance misuse has been one of the areas that has been hit hardest (The Kings Fund, 2017). Funders therefore face difficult decisions. When treatment budgets moved to public health departments, my initial fear was that ‘tough on the causes of crime’ wouldn’t be as powerful an argument for public health professionals, and so services like methadone prescribing would be squeezed. This has happened to some extent, but generally not because resources are being redirected to prevent alcoholrelated issues. It’s simply the result of the overall budget cuts. Interestingly, a different set of arguments have been found to justify public health expenditure on drug treatment: reducing mortality; reducing communicable diseases (like HIV and Hepatitis C); and reducing health inequalities. So my fear today isn’t the same as it was five years ago. There’s a certain logic to housing substance misuse treatment and prevention in local authorities, given the complementary responsibilities for licensing, planning, community safety, housing, families, education, prosperity and wider social issues such as social care. But that wide range of interests – to reverse the management cliché – doesn’t just offer opportunities, it also presents challenges. If we’re in a competition for resources, which will surely only get more fierce with the likely removal of the ringfence on the public health budget in 2020 (Department of Health and Social Care, 2018), then those other responsibilities represent competing claims as much as complementary activities. And of course, the potential competition for resources isn’t just within local authorities, but with other organisations, like hospitals, GPs, the police and so on. Therefore, just as I was afraid in 2013 that the rationale for drug treatment wouldn’t persuade public health practitioners, I now worry that neither local authorities nor other organisations will be persuaded of the value of treating substance use disorders regardless of the substance involved.
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An aggressive retreat But this discussion of competition is slightly misleading. In my experience, it doesn’t feel like different organisations are fighting over their share of the cake. Instead, it can feel more like they’ve each
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taken their share and are hiding in the corner, hoping someone else gets caught in the spotlight. This is particularly true if we broaden our concern to all of the organisations involved in that ‘messy’ picture of delivering support for someone who might have run into issues linked to alcohol. Once it’s accepted that there isn’t enough money to go around, the game seems to change. It’s no longer about getting hold of enough funding to do the best job you can. It’s about redefining your job as narrowly as possible so that you can focus your limited resources and not get blamed for any adverse incidents: you can say that a particular problem isn’t your responsibility. This applies just as much to organisations as individuals: pressured local authorities focus on their statutory duties, and hospitals worry about emergency department waiting times. Too often, although calculations can demonstrate the value of an intervention – the social return on investment – the question is whether these savings are ‘cashable’ and who they accrue to. Will a local authority invest to save an NHS acute trust money? Perhaps it’s not so much organisations competing against each other as aggressively retreating, leaving behind problems for other organisations and the system of public services more generally. The characteristically messy issue of ‘dual diagnosis’ is a case in point. This refers to people who have been diagnosed with a substance use disorder and a mental health issue. Substance misuse services should interlink and work hand in hand with mental health services. But of course budget cuts and the retreat in responsibilities mean that cracks appear. Those with the most severe mental health issues still meet the thresholds of Community Mental Health Teams (CMHTs), and those at the lowest levels can have their mental health issues reasonably well dealt with by substance misuse services. It’s those who don’t meet the thresholds but whose issues are beyond the confidence or competence of substance misuse professionals who I’m worried are falling through the cracks. This isn’t really, therefore, about competing providers; it’s the funders and commissioners who are more likely to talk about ‘core business’ and be keen to define responsibilities tightly so that ‘their’ money gets spent delivering ‘their’ outcomes. Sadly, this competitive dynamic isn’t simply about substance misuse challenging other local organisations, or even alcohol competing with other drugs. There’s a competitive element within our sector. Even that word ‘sector’ is revealing. In my experience, substance misuse staff and service users are more likely to refer to ‘the sector’ than those working in mental health, for example. Other areas of health or social care might refer to a ‘specialism’ or a ‘profession’, but not a sector. They would see themselves as part of the healthcare system, or the local authority. This idea of a ‘sector’ is partly the result of a competitive market for contracts. Rather than being the collective term for local
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the psychologist july 2019 alcohol
authorities, or even different NHS that’s not to say they shouldn’t trusts, it refers to a set of competing work closely with both. Life is organisations, both charities and about more than individuals or NHS trusts, as well as potentially families. There is, or should be in private companies. this context, such a thing as society. Again, this is largely the result What we need to move beyond of structures and regulations this impasse – even if the times actively created by policymakers of plenty return – is a genuine and public sector employees Will Haydock is a visiting fellow change in culture and approach like me. Drug treatment was at Bournemouth University and to something more cooperative, something of an outrider in the also works for Public Health even collaborative. Reflecting on ‘new public management’ of the Dorset. william.haydock@ my own experiences working in New Labour years, with substance dorsetcouncil.gov.uk various roles on the commissioning misuse treatment not simply being of substance misuse treatment delivered by the NHS or social services, we – I – need to become less defensive. More workers ‘in house’ at the local authority, but through open to criticism and the change it might produce. multi-million-pound contracts awarded to the highest (or rather lowest) bidder. In some cases, what had been More open to working with different people, with different aims and life philosophies. small charities prior to the 1980s resembled major This may sound trite, and the response from some corporations by 2010 (Mold, 2012). service user groups to this kind of exercise is often, But this idea of competition within the sector isn’t quite rightly, ‘you talk, we die’. But this shouldn’t be just about organisations; it’s about philosophy and just ‘talk’ about the abstract idea of changing culture. ideology too. Different people understand treatment as It should be about action – practical decisions. Let’s having different aims, a debate often characterised as a get service users, providers, commissioners, budget battle between ‘harm reduction’ and ‘recovery’. Indeed holders, elected representatives and members of the A. Thomas McLellan and William White have referred wider public in the same rooms, sitting round the to this argument playing out in relation to treatment same table, discussing the issues they all care about. for opioid use disorders as the ‘methadone wars’. I’m not just thinking of substance Personally, I see these two ideas misuse; I’m thinking of that whole as complementary – unless you set of ‘messy’ interests including reduce the harm from substance “…overall public health employment, housing, education, misuse a person will die, and you budgets are being and other health and social care can’t recover if you’re dead – but this approach is seen by some as a reduced year on year, and organisations. Let’s be clear about what we’re trite way of ducking the question. substance misuse has trying to do and why. And let’s be Which side am I really on? been one of the areas that clear about what we can’t (or won’t) do, and why. If we decline to take has been hit hardest” appropriate action because we You talk, we die won’t reap the benefits (personally, How can we get beyond these ideas or as an organisation), that’s fine of competition? It’s not just about – but let’s make that clear to the people who use our rethinking the flawed idea of commissioning, though services and their families, and the wider community. that’s crucial. And equally it’s not just about finding a magical consensus definition of ‘recovery’. Even if there I’m not sure they’d be sympathetic to the GP who won’t conduct alcohol screening because they’re not wasn’t competition for contracts, and even if we could agree on the terminology in our ‘sector’, the confusing, specifically paid for it; or the hospital trust that won’t invest in alcohol liaison services because they save overlapping, messy nature of substance misuse as a the local authority money on social care; or the local problem would remain. We’d still need to work across authority that won’t fund preventive work because the and within different organisations and departments savings accrue to the NHS. and reach out beyond that sector. This can’t be These conversations are already happening in some remedied by a great reform or change in structures or places – like Plymouth, for example – but this level of ideology. genuine partnership and public debate and scrutiny is I’ve recently heard young people’s substance rare. I want to make a general call for us to stop hiding misuse services criticised because they don’t feel in the corner with our piece of cake, and come out into part of ‘the health family’. That’s perhaps because the spotlight to openly say what we’re doing and why. they’re not commissioned or delivered by a Only then can we work together much more efficiently healthcare organisation, they don’t employ healthcare and effectively. After all, as Louis Brandeis said, professionals and they don’t really deliver healthcare. ‘sunlight is said to be the best of disinfectants; electric Equally, they probably don’t feel part of the local light the most efficient policeman’. authority family, for many of the same reasons. But
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‘These are big, contentious conversations’ Nathan Filer is a qualified mental health nurse, and currently Reader in Creative Writing at Bath Spa University. Nathan’s first novel, The Shock of the Fall, about a man grieving the loss of his brother, won multiple awards including Costa Book of the Year. Here, Nathan tells us about his new non-fiction book, The Heartland: Finding and losing schizophrenia, which is out now.
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You talk about the issues with diagnosing schizophrenia: that the term can be misleading to patients, that it can get in the way of research, and that schizophrenia may not even exist. Do you think there is still use in this diagnosis? I do say all of those things, don’t I? These are big, contentious conversations. I believe it’s best to always bring them back to real people and real experiences. In The Heartland I interview a woman named Clare.
Her teenage son, Joe, had a diagnosis of ‘hebephrenic schizophrenia’ – as characterized by disorganised thoughts and flattened emotions. He was extremely disruptive and chaotic throughout his early adolescence, before his life was tragically cut short. He died when he was just nineteen years of age. Clare told me how she had taken some comfort in Joe’s diagnosis because it helped her to make sense of his behaviours. Only here’s the thing: since Joe’s death, ‘hebephrenic schizophrenia’ has technically ceased to exist. It never made the cut for the latest edition of the DSM – psychiatry’s official taxonomy, commonly referred to as its ‘bible’. In 1973 homosexuality was officially a mental Emily Parker
Why did you choose to focus on schizophrenia, rather than mental health more broadly? I’ve used schizophrenia – or rather the unusual thoughts, feelings and behaviours that are commonly called ‘schizophrenia’ as a point of entry into what I hope is a much wider exploration of the concepts of mental health and illness. Partly, this decision was made for me. At the heart of the book is a series of personal narratives. Some of these are the stories of people who read my first novel The Shock of the Fall (which is about a young man with a schizophrenia diagnosis) and who took the time to reach out to me in order to share their own stories – true stories – about living with this most unusual of human experiences. The Heartland: Finding and Losing Schizophrenia by Nathan Filer is out now Why is your book called The Heartland? Schizophrenia was traditionally called ‘the (Faber & Faber, £14.99). heartland’ of psychiatry; the condition that all but defined the discipline. It’s an emotive, Read an extract on our oddly territorial description. It’s not a phrase website… used today, but I think it remains apt to describe what is a highly emotive and proprietorial debate. Almost everything about schizophrenia – from causes to treatment, and indeed to whether it truly exists – is subject to fierce and frequently acrimonious debate. The heartland, it seems to me, has become the scarred battleground upon which the most entrenched ideological disputes over madness and its meanings are fought. So yes, I figured it’d make a decent title for a book on the subject.
Nathan Filer
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the psychologist july 2019 books disorder. By 1974, thankfully, it was not. And it was the voice of feminism that won the argument against ‘premenstrual syndrome’ and ‘masochistic personality disorder’ (read: the domestic violence you’re suffering from is actually something that’s the matter with you) being classified as mental illnesses in the late 1980s. Determining which of our thoughts, feelings and behaviours are disordered and which are not is a social and political exercise as much as it is a scientific one. Indeed, Dr Steven Hyman, a former director of the US National Institute of Mental Health has stated that the categorical diagnoses of the DSM represent ‘an absolute scientific nightmare.’ How we label people changes over time. Meanwhile, Joe remains dead. And Clare must live with that absolute and unalterable fact. These are the kind of things that I seek to explore in the book. You describe how institutional racism has led to disproportionate sectioning and medicating of black and minority ethnic patients. What should we be doing to counter this? As a white person who has never been sectioned, I don’t suppose I’m especially well qualified to answer that. But I suspect that one area worth focussing on is staffing. In the UK, people who experience psychosis and so-called schizophrenia are disproportionately black and male, whereas clinical psychologists are disproportionately white and female. In a recent independent review of mental health services, it was noted that clinical psychologists do not necessarily have training in ‘transcultural therapy’ or a deep understanding of specific issues relating to racism and discrimination. As I discuss in the book, this may result in black and minority ethnic people being less likely to engage in – or to be offered – the kind of therapies that can reduce distress and mitigate against enforced hospitalisation and medical treatments. The book ends with a call to arms. What would you like us – psychologists and non-psychologists alike – to do? A couple of interviewers have told me that it ends with a call to arms, so perhaps it does. But I wasn’t really aiming for that. What I was aiming for was a call for people to take a seat in the conversation. It’s brilliant that conversations about our mental health have become that much more prominent in recent years – especially those around depression and anxiety. There’s now less stigma associated with having those kinds of feelings. But I worry that this discourse has gotten broader without getting deeper. I hope that The Heartland will encourage people to think a bit more deeply about the phenomenon that we call mental illness, and to explore different ways of understanding it. I want everyone to be part of this conversation: for each of us to feel brave enough to speak, and brave enough to listen.
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A Good Enough Mother Bev Thomas Faber & Faber; £12.99
A fascinating reflection Reading non-fiction by psychologists about their areas of expertise is nothing new for most of us. But reading a psychological thriller by someone who has spent their career working in applied psychology is certainly something different, and this book was a real treat. It beautifully describes the realms, difficulties and approach of the fictional psychotherapist Dr Ruth Hartland interwoven through a fascinating narrative in a way that a non-psychologist would really struggle to achieve. As a parent and psychologist, the interaction between personal and professional caused much contemplation, especially as Thomas skilfully draws the worst fears of both parents and therapists into one story, unveiling them slowly as the chapters develop. I felt the novel would be particularly valuable for those working on the outskirts of mental health support or for students wanting to understand the importance of barriers, honesty within supervision, reflection and process within psychotherapy in a far more accessible and effective way than any textbook. I imagine for those working in the field it would prompt a fascinating reflection on how they would approach clients similar to those Hartland treats. For those completely outside of psychology it is just a great read with some unexpected twists. Reviewed by Josephine Perry, chartered psychologist, Performance in Mind Find an interview with the author on our website
Sharing collective myths the most valuable of these myths 21 Lessons for the 21st Century is in danger from next-generation completes Professor Yuval Noah information technologies. Harari’s trilogy about humankind. The book amalgamates various Sapiens charted human history talks and publications, making it with great insight and clarity – lumpier than Sapiens and casting humans as the Deus. Important assertions planet’s storytellers. Deus come and go in single projected humanity to 21 Lessons for 2050+ when brains will the 21st Century paragraphs – while, in almost every chapter, merge with machines Yuval Noah Harari illustrates human and be governed by Harari weakness with gratuitous computer algorithms. Jonathan Cape; caricatures of religious 21 Lessons… returns us £12.99 belief that he demolishes to the present, to explore with righteous fervour. the psychological and Unsurprisingly then, the most philosophical challenges facing 21st constant lesson that emerges from century humans – exploring what 21 Lessons… is Harari’s argument it means to be human in an ‘age of for secularism over religious faith. bewilderment’. We must embrace science, not false Harari’s over-arching thesis is gods – and understand the difference that human success has been based between observed evidence and on the sharing of collective myths mere belief. (such as liberalism, equality, human Alas, Harari’s positive depiction rights, and gods). The endurance of
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of science is as credulous as his negative depiction of religion is narrow-minded. If he is aware that the behavioural life-sciences are characterised by human biases of every conceivable type – and some wildly hubristic claims – it is not obvious. Harari declares as established truth, for example, that neuroscience has now ‘hacked the human brain’, and proved that humans are soulless bio-machines lacking free will, significance and meaning. A priest could very fairly riposte these are merely statements of Harari’s faith – the opinions of a historian unable or unwilling to see that neuroscience is still in its stumbling infancy… Hasn’t history
Stranger in the Mirror: The Scientific Search for the Self Robert V. Levine Robinson; £14.99
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shown repeatedly that scientists (and brilliant historians) are just as prone to hubris, selective perception, self-delusion – and plain vanity – as everyone else, yea, unto the biblical prophets? To such reasonable misgivings,
Professor Harari is deaf. 21 Lessons states his vision, very eloquently, of a determinist, Eaglemanesque humanity – doomed to a future of brain-merged bio-tech that can only be relieved through meditation. And he countenances no alternatives. Happily, for those of us who prefer to find our realities in modest hedonism, Harari’s evidence for this dystopian future is weak and narrow-minded – certainly no basis, just yet, for shoving Moses out of the way to carve yet more thinly-tested hypotheses into tablets of stone. Reviewed by Chris Timms, who taught psychology at colleges and universities for 25 years
The multiplicity of the self It was the venerated 20th century philosopher, Popeye the Sailor, who once uttered the immortal line ‘I yam what I yam’. It may not be the most profound statement, yet it accords with one school of thought on the self; that each of us has a core ‘true’ self, which is stable, authentic and consistent. There’s certainly something comforting in the belief that each of us has a unique set of persistent characteristics which help to define us as individuals, particularly in an ever-changing and unpredictable world. But discoveries in the field of neuroscience are starting to cast doubts on this perspective, and this is one of the areas Levine delves into in Stranger in the Mirror. If you’re looking for a ‘whodunit’ type revelation to the question: ‘Where does our sense of self come from?’ (Was it the ‘brain’ in the pantry with the lead pipe or the ‘collection of our lived experiences’ in the kitchen with the rope?), you might be disappointed. The answer seems to be, we don’t really know quite yet. If you’re looking for a cliff-hanger about how academics prefer to conceptualise the self, you won’t need to take a sneaky peak at the last page to get your answer. Indeed, Levine gives the game away in the opening chapter – ‘we are more like a republic than an individual, a collection of the many, diverse and sometimes adversarial’, or using my girlfriend’s favoured analogy, the self is a collection of ‘boroughs’. I’ve found that the trick is in knowing which particular ‘borough’ you are interacting with at the moment. The self is multifaceted, it is dynamic and it is ephemeral. But that’s not to say that the journey to understanding the nature of self is not a fascinating one and in Stranger in the Mirror Levine guides us expertly through the diverse research endeavours which have sought to answer one of the human race’s most enduring existential questions; ‘who am I?’. Levine draws upon assorted case studies, theoretical perspectives, philosophical treatises and cutting-edge research to shed light on the multiplicity of the self.
Given my background in cyberpsychology, I was particularly enthralled by the section in which he discusses the use of virtual reality for body swapping. The ease with which users seem to readily accept another’s body part as their own throws up thoughtprovoking questions about the extent to which we define ourselves by our physical appearance, and how easily we could adapt to extreme body modifications. From mirrorself misidentification syndrome to dissociative identity disorder, Levine highlights the fragility of the self and how the notion of a fixed identity may in fact just be an elaborate illusion. This book will certainly get you thinking and there is so much to like; it is engaging and it is uncompromisingly diverse in its coverage. I found the book to be an immaculate combination of challenging yet accessible (although at times it feels like, as a social psychologist, Levine is more outside of his comfort zone with the ‘harder’ neuroscience literature). You may come away feeling much less sure about who you are than when you started. Old hands like myself, who teach and research the self, have started to become more comfortable with these ideas, but for those who cling to the notion of a unitary and stable self, this can be a disturbing and difficult to reconcile revelation. To quote another deep-thinking fictional character, Detective Rust Cohle from the TV series True Detective, ‘I think human consciousness, is a tragic misstep in evolution… we are things that labour under the illusion of having a self; an accretion of sensory, experience and feeling, programmed with total assurance that we are each somebody, when in fact everybody is nobody’. A charming, engaging and always intriguing exploration of the nature of self – recommended reading. Reviewed by Chris Fullwood, Reader in Cyberpsychology, Department of Psychology, University of Wolverhampton
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the psychologist july 2019 books
How Freud hijacked the most heated debate of all time If it’s true that the dead don’t rest in peace until their name is no longer spoken on earth, then Freud must resign himself to restlessness for eternity. This book describes the enthralling story of how the founding father of psychology hijacked the most heated and unresolvable debate of all time: how can we understand human nature? Alexis A. Johnson offers a clear and insightful primer for students of psychiatry, psychology, psychotherapy and counselling, with a step by step tracking of 150 years of psychological theory, complete with a comprehensive glossary of terms, case studies, and references for further reading. The book also creates a narrative that operates on an entirely different level for the mature practitioner: a profound professional and personal journey of
discovery that engaged my mind, my heart and my very soul. Starting with Freud’s revolutionary new theory of psychoanalysis, Johnson shows both how theory underpins practice, and how practice moderates and revises theory, usually over a long period of time as anecdotal evidence slowly accumulates. This theoretical history is supplemented and supported by a tapestry of case studies along with commentary on Johnson’s own experiences of consulting work. This thread of practice illustrates and enlivens the theoretical discourse, creating an engaging narrative with relatable characters and a compelling voice. By the end of the book, we see the radical volte-face that occurred, from the austere froideur of Freudian psychoanalysis focusing on past
trauma, to the warm encounters of the relational therapists, focussing on the present, and its obstacles to future thriving. As the book takes us ever further from Freud’s original vision of psychoanalysis in theory and in practice, we are faced with a mind-bending turning of the tide, as Johnson reverses the timeline, circling back to Freud and his early followers to discuss the impact of neuroscience on the fundaments of psychoanalysis. I won’t spoil the story by revealing the denouement, but this last perspective of the ebb and flow of ideas, and how they impact and moderate each other both backwards and forwards, was a deeply satisfying end to this fascinating book.
Introduction to Key Concepts and Evolutions in Psychoanalysis: From Freud to Neuroscience Alexis A. Johnson Routledge; £32.99
Reviewed by Voula Tsoflias, chartered psychologist and novelist
They just need to care In The Year I Didn’t Eat, Samuel Pollen tells the semi-autobiographical story of 14-year-old Max Howarth through an account of what happened from one Christmas Day to the next, punctuated by letters to his eating disorder, Ana. As an account of a teenage boy’s experience suffering with anorexia nervosa it’s particularly welcome, and it is very engagingly written with characters that really bring the story to life. What Pollen skilfully manages to do in this enjoyable book is describe one young person’s experience of an eating disorder, whilst weaving in comments about thoughts and feelings that underlie the illness. He uses Mr Edwards’ GCSE biology lesson to tell the reader some facts about anorexia’s impact on the body, and we get snippets of his sessions with his therapist Lindsay giving insights into his thinking and into how she goes about trying to help him. The book is likely to appeal to teenagers with eating disorders and their friends, but Pollen also makes the book useful to parents and siblings, partly through making
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Max’s brother Robin something of a hero in how switched-on he is to what will help Max. Robin introduces Max to geocaching, and this weird way of connecting with other geocachers becomes one thread in Max’s recovery. Max’s PE teacher is also an important figure. Those who know someone struggling with an eating disorder may find it helpful to hear what Max says: ‘Someone doesn’t need to understand you to save your life. They just need to care.’ Reviewed by Dr Helen McCarthy, AFBPsS Consultant Clinical Psychologist and author of How to Retrain Your Appetite. We asked Samuel Pollen a couple of questions. What do you wish you had known when you yourself were struggling with an eating disorder? That people recover every day. It sounds obvious – of course they do – but when you’re going through an eating disorder, you get very good at telling yourself that your situation is uniquely hopeless. It isn’t.
The Year I Didn’t Eat Samuel Pollen ZunTold Books; £7.99 I’m not saying it’s easy – it never is. But there’s every chance that you can get through it, and come out stronger on the other side. Anorexia is a frightening illness for families to see a relative suffering from. Are there any words of advice or comfort you would give them? Well, first of all, it isn’t your fault. Eating disorders happen, like lightning bolts falling from the sky. They just do.
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Authentic portrayals Rosa Cheesman and Alicia Peel (King’s College London) tune in to the BBC series ‘Mental Health and Me’
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he BBC’s recent series of documentaries triggered public discourse about life with mental health conditions. Anxiety and Me tracked Nadiya Hussain’s journey from Googling her symptoms through to starting cognitive behavioural therapy. Depression and Me followed Alastair Campbell trialling a range of more novel treatments for depression, including transcranial magnetic stimulation, and exploring the link between depression and the immune system. In Psychosis and Me, David Harewood pieced together what led to a previous psychotic episode, and learned about others’ experiences. The films encouraged people to openly talk about their mental health, and to seek treatment if they are struggling. In addition, the series provided a window on these conditions, framed from the perspectives of the individuals involved. The huge, positive reaction on Twitter highlights the general desire there is today to open up the dialogue about mental health. As these documentaries were designed for the public, not for psychologists, it is important to review them from that perspective. Despite high levels of support from viewers, criticism ensued on Twitter, primarily from psychologists and mental health professionals. These focused on the language used and the advice provided to the celebrities. However, as has been argued previously by Vaughan Bell and others, individuals should be allowed to speak for themselves and tell their personal stories, even if aspects of these are specific to their own experience.
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Alastair Campbell
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‘If I break my finger, I go to accident and emergency. If I have a cold, I go to the pharmacy. If I’m broken inside, where do I go? So, to help myself heal, I felt the best way to do this would be to talk, to share and to better understand what it is that I have.’ Nadiya Hussain Indeed, the reason why these documentaries are so powerful is that they are so deeply personal. They give us access to the private lives of household names, highlighting that what we see on the outside – confidence and success – does not necessarily reflect how people feel on the inside. These authentic portrayals help us all to see how impairing depression, anxiety and psychosis can be. Presenting such honest accounts of these conditions is a huge step towards increasing general knowledge and understanding of mental health. Whether these presentations fall in line with the beliefs of all mental health professionals is less relevant to the impact of this series than their overall positive influence on the public. The films effectively communicate the complexity of the conditions and that they involve many risk factors. Collectively, they cover how genetic risk and experiences, including trauma, can all influence our mental health. Alastair Campbell and genetic counsellor Dr Jehannine Austin discuss the ‘jam jar’ model for vulnerability and resilience to mental illness. In this model, mental health is represented by a jam jar. At birth, some genetic risk factors are already present in a person’s jar. Throughout life, environmental adversities also start to build up. Once the jar is full and a person has no more room to cope with environmental stress, a psychiatric episode
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the psychologist july 2019 culture is experienced. Crucially, the model incorporates the ability to increase the size of the jar, by adding protective factors such as exercise, sleep and social support that enable us to cope better with environmental adversity. Nonetheless, the intense focus of these films on individual experiences also poses challenges. The experience of a psychiatric disorder is rarely the same for any two people. If the aim of this series is to increase awareness and understanding, then it is important to address how differently these conditions can present. Although Nadiya mainly struggles with panic, other anxiety disorders including generalised anxiety, social phobia and obsessive compulsive disorder are also highly prevalent. Knowledge of their specific symptoms and difficulties could go a long way towards reducing stigma. Hopefully with the increasing popularity of these programmes, other stories will be told which cover different manifestations of anxiety and depression. This will ensure that viewers can understand the huge diversity, even within conditions under the same name. David Harewood’s Psychosis And Me presented different manifestations of psychosis experienced by individuals attending an early intervention group. This segment of the programme showed a greater appreciation of the possible range of psychotic experiences. The difficulties discussed by those interviewed brought to light the reality that many do not only experience one episode of psychosis, as he had. Rather, most suffer with more chronic and debilitating manifestations. Including these individuals helped to portray that mental health difficulties encompass a full spectrum of symptoms, ranging from individuals who may experience subclinical symptoms with minimal impact on their functioning, to those with more severe mental health conditions who may face daily battles with their mental health. A clear take-home message from the films is that it is good to seek help. Having been part of these documentaries, Nadiya and Alistair had the opportunity to try numerous treatments, expanding public knowledge of standard and novel therapies and research directions. Yet, beyond these programmes, many people in need of mental health services still face barriers to accessing treatment. These documentaries should lead us to think not only about what the individuals themselves can do to support their own mental health, but what can be done at a societal level to reduce these barriers. Recently, major progress with this has been made with the NHS Improving Access to Psychological Therapist service (IAPT), with 89 per cent of patients seeking support for anxiety and depression starting treatment within 6 weeks. Thanks to the bravery of these celebrities mental health is on the agenda more than ever before. With documentaries like these receiving ever-increasing support from the public, future programmes have the scope to address more nuanced aspects of mental health.
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The rawness of pain and loss placed him as ‘radical thinker’ and he I had the privilege of visiting this spent much of his time with women exhibition on its opening weekend. and men who believed that the role I have never really had the patience of women in society should change. for art, much to the chagrin of my Once he met his wife, his art became various art teachers in school. bright and colourful, indicating the However, there is something about love that he felt for his partner. ‘The Scream’ which has always More intriguing to my mind, caught my attention and I felt however, is what comes next. compelled to see it first-hand. Munch and his wife separate, a young Far from being a secondary member of his family perishes, and school modern art lesson, this he suffers and struggles. exhibition is a lesson His artworks are now full in the expression of of sadness, fear and pain. emotion through different exhibition art techniques. Most of Edvard Munch: What Munch achieves, is Munch’s artworks are Love and Angst to use his print technique made using prints and the British Museum to illustrate the facial and physical expression of original wooden carvings emotional pain without the to make the prints are mask that we often use to cover the available in the exhibition. What hurt we feel inside. Grief, anxiety, makes this so wonderous, is that sadness and fear are difficult Munch manages to capture emotions emotions to capture – our individual which are often intangible using expressions, combined with our these carved print techniques. learnt coping strategies, make these The exhibition works through emotions challenging to pin down. Munch’s own As observers we are drawn to these emotional images – with The Scream just one discoveries, amongst many – because Munch starting with replicates the rawness of anxiety, artworks pain and loss in the moment before reflecting we have a chance to conceal it. a conflict between desire Love and Angst runs at the British and fearing Museum until 21 July the power of Reviewed by Ciara Wild, a chartered women. At the psychologist with Her Majesty’s Prison time (1863– and Probation Service 1944) this
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exhibition Brilliant Visions – Art, Mescaline, Psychiatry Museum of the Mind
tv Mothers on the Edge BBC
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A lesser known history of psychedelics
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lmost a century ago, a hallucinogenic drug derived from the peyote cactus became the subject of fascinating psychiatric experiments. Known as mescaline and the subject of Aldous Huxley’s book The Doors of Perception, it seemingly has a profound effect on the human psyche. Its effects can be seen at the new exhibition Brilliant Visions – Art, Mescaline, Psychiatry at the Museum of the Mind. Both visually satisfying and bemusing, it invites visitors on a vivid incursion through the mescaline experience and the scientific practice of the striking experiments with surrealist artists, writers and philosophers that began in the 1930s. Co-created by Mike Jay, historian and author of Mescaline: A Global History of the First Psychedelic, and artist Kate Tiernan, the collection offers rich visual and written accounts of the psychiatrists Guttman and Maclay’s experiments at the Maudsley Hospital in South London and studies further afield. The works on display include those of Basil Beaumont, Julian Trevelyan and Herbrand Williams, together with rarely-seen but beautiful and attention-demanding artwork from anonymous artists. The hallucinations triggered by the drug resembled episodes of psychosis, and so Guttman and Maclay aimed to better understand what patients with psychosis experienced during their episodes. At the time, patients were increasingly
encouraged to use spontaneous drawings to understand their symptoms. However, they were not always able to materialise their inner experiences through this means of expression. The drawings showcased are a riot of colour and curious lines. Illustrator Louis Wain’s kaleidoscopic cat depictions are a pertinent example: over the four drawings displayed, the carefully detailed image of the cat loses precision as the drug takes effect, eventually dissolving into colourful patterns. Other works such as those of Beaumont and the Romanian painter Michăilescu take the viewer to even more abstract territories inspired by the psychedelic trip. For surrealists, the mescaline experiments provided an opportunity to tap into the creative power of the unconscious mind. ‘I could not put a line wrong… Perspectives and recessions dripped off my pencil’, artist Julian Trevelyan famously wrote when describing his experience. Yet, some paintings are filled with a sense of unease. ‘Lots of artists found it rather difficult and unpleasant – they felt like they were treated like guinea pigs. They were given this drug that was a rather mechanistic way of producing hallucinations or changing their state of perception and consciousness and were told to draw. Where is the agency? Where is the intention?’, Jay concedes. Perhaps the research raised more questions than they answered, considering today’s stringent ethical approvals. Harmonically bridging the arts with science and psychiatry, Brilliant Visions prompts visitors to reflect upon the workings of the mind through altered states. In the wake of promising results from psychedelic drugs such as magic mushrooms in treating depression and post-traumatic stress disorder, it brings context to today’s psychedelic renaissance, revealing a history unfolding before the word psychedelic was even coined. The exhibition is on at the Museum of the Mind until 31 August 2019. Reviewed by Alina Ivan, King’s College London
Stories which need to be told Louis Theroux spoke recently about how his film-making style has changed, from looking to expose ridiculousness in the early days to a more nuanced, sympathetic way of relating to interviewees and subject matter. I watched Mothers on the Edge a little on edge myself – these women and their babies are so very vulnerable, and I was concerned that we might not see enough of the latter Louis. By and large, he managed pretty well, helped by a seemingly natural engagement with both the
mothers and the babies, and an ability to intuit when he should back off. Mothers spoke of guilt, pain and failure to live up to society’s expectations (including having to project a perfect image through social media). The documentary explained that depression is just one facet, also telling the stories of women with diagnoses of psychosis, post-traumatic stress disorder, and emotionally unstable personality. The humanity of those involved in their care was striking. Dr Trudi
Seneviratne at the Bethlem Hospital leads a team which shone through as doing the best possible work in the most challenging of circumstances. Society does not want to believe that a woman can feel indifference for their child, or ambivalence, even hatred. The reality is that many do, to various extents, for various periods. These stories need to be told. Reviewed by Sally Marlow, Associate Editor for Culture. Read more in the online version.
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the psychologist july 2019 culture
Brilliantly disturbing This is a really disturbing exhibition on many levels. It features three screens, each with the same CGI young woman, whose face for much of the films is flawless. In one she struggles to shed a transparent fat suit which encases her body, inflating and deflating, at times giving her the torso of a male body builder, at times a layer of fat, and at times simply an extra layer of baggy, saggy skin. Her face becomes bruised, and as the video plays on a loop, there is no escape from her agitation and powerlessness against the morphing shape of her body. To say it struck a chord is something of an understatement.
Onto the next film, where the same flawless woman sleeps, wakes, is surrounded by symbols of housework, pleads with some unseen figure, and bleeds from her face. Decaying hands float in the background. This film found its mark with me too. In the final film the woman is wearing flesh coloured sports kit, and battling to keep pace on a conveyor belt, but she is crawling not running – this is not a gym machine, but a belt you would find in a factory or delivering luggage. Exhausted, she slips back, starts crawling again. The cycle repeats and repeats. It’s hopeless, seeming destined to be her fate, but
then suddenly she is in a garden, and her face turns to beautiful, perfect flowers – but is it her face? The use of CGI added another layer to what felt like a deeply feminist exploration about women’s struggles for bodily perfection, and their gendered roles, suggesting these are more than objectified: they are stylised and created. Arguably in real life this is how it is, and women and men continue to buy into that. I left feeling destabilised, uncomfortable and agitated, and not a little depressed. It was brilliant.
exhibition Kate Coope Haywood Gallery
Reviewed by Sally Marlow, Associate Editor for Culture
‘Smoke and mirrors: The psychology of magic’ runs at the Wellcome Collection in London until 15 September, with live events throughout. Gustav Kuhn and Matthew Tompkins went along – read their review at https:// thepsychologist.bps.org.uk/timelytool-understand-mind-manipulation
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From the bomb to Apollo 13: Bowlby and the Cold War How did child psychologists contribute to the Cold War discourse of ‘National Security’? Carolyn Laubender discusses the relationship between attachment theory and political anxieties about the protections offered by the nation state.
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John Bowlby (above). Nuclear family in nuclear shelter (top)
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ohn Bowlby’s career as a child psychologist and psychoanalyst spanned the roughly four decades of the Cold War, starting in the 1950s and continuing up until his death in 1990. Although Bowlby had worked with ‘delinquent’ children in schools and state institutions throughout the 1930s and 1940s, his most renowned and influential work began in 1951 with the publication of his bestselling book, Maternal Care and Mental Health. This text sold almost 500,000 copies in English alone and was translated into six different languages in Bowlby’s lifetime. After its initial publication, it became a staple for experts and lay-people alike, inspiring countless self-help parenting books in the decades to come and launching Bowlby into the public eye as a postwar specialist on child psychology. Yet, Maternal Care and Mental Health did not begin as a public-facing self-help book designed to satiate a generation of transatlantic baby boomers newly fascinated with ‘expert’ advice on childrearing.
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After World War II, the World Health Organization commissioned Bowlby to write a report on the state of homeless children’s mental health and emotional wellbeing. In light of the massive urban air raids throughout the war and the consequent exodus of children to the countryside – not to mention the largescale Kindertransports that had ferried Jewish children out of Germany and surrounding countries before the outbreak of the war – many children living in the UK were left either orphaned or permanently separated from their families. Children’s institutions expanded throughout the UK to answer this postwar need, including the Bull Dogs Bank Home, the Tavistock Clinic, and the Hampstead Nurseries. Child psychologists and psychoanalysts, like Bowlby, Anna Freud, and Donald Winnicott, lent their specialties to both governmental and non-governmental initiatives alike, which strove to safeguard the children of a nation. During the war and immediately after it, Bowlby worked in some of these children’s institutions, seeing
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the psychologist july 2019 looking back
‘Security’ was thus born, practiced, children who had been severely and produced in the domestic traumatised by wartime violence Carolyn home, through the psychologies and separation. But when writing Laubender is a that mothers cultivated in their his report for the WHO – the report Lecturer in the children. As the Cold War escalated, that would become Maternal Care Department of the mother ensured ‘domestic and Mental Health – Bowlby did not Psychosocial and security’ on all fronts. defend the necessity of the statePsychoanalytic But child psychologists like sponsored children’s institutions Studies at the Bowlby were not the only figures where he had worked. Rather, University of Essex, where she throughout the Cold War interested he championed the necessity of is also the director of the BA in producing security. Indeed, the specifically maternal care, insisting Programme in Childhood Studies. discourse of ‘security’ was on the (through the very title of his text) Her current monograph project is move in many spheres, gaining that it was maternal care that was The Child in Mind: Psychoanalysis, traction as an aspirational virtue indispensable for children’s mental Politics, and the Clinic. not only within child psychology health. According to Bowlby, what c.laubender@essex.ac.uk but also within politics. During the was ‘essential for mental health’ was Cold War, Britain, like the US, felt not public support or even clinical This article was originally acutely that Eastern European and intervention, but a ‘warm, intimate, published on the Birkbeck ‘Hidden Asian communisms introduced a and continuous relationship with Persuaders’ blog, and is reproduced ‘national security’ crisis, one that [the] mother’ (Bowlby, Maternal with permission. posed a dual threat to the West’s Care and Mental Health, 67). On global capitalistic expansion and to Bowlby’s reading, neither state welfare nor group homes were sufficient for the project global military peace. In fact, the US National Security Act of 1947, the document that codified the discourse of developing ‘secure’ child psychologies. Even the of American ‘national security’, was also the document best group home was but a meager substitute for the that inaugurated the what many consider to be the first incomparable effects of a mother’s love. official year of the Cold War, for Britain as for the US. Over the course of his career, Bowlby would work What this means is that, from a Western perspective, to develop, refine, and support these early claims Cold War politics are inseparable from the political about the determinative importance of maternal care project of ensuring national security. Only during the for childhood wellbeing, crafting a unique theory of Cold War, with its combined military and politicalchildhood psychology known as ‘Attachment Theory’. As Bowlby expanded his work, he culled research from economic crises, did the discourse of ‘national security’ truly find its footing. psychologists like Mary Ainsworth and ethologists It was in this exact historical shift that Bowlby’s like Harry Harlow and Konrad Lorenz. From this, he proposed that the attachment bonds that children form work on childhood emotional security emerged and found an audience. The very span of Bowlby’s with their primary caregiver – a figure that Bowlby unflinchingly argued ought to be the biological mother publications – from Maternal Care and Mental Health in 1951 to A Secure Base in 1988 – bookended the – were determinative of the child’s future capacity decades of the Cold War. In this way, Bowlby’s for ‘secure’ or ‘insecure’ relationality. In Bowlby’s work registers the dual ascent of psychological understanding, children were preprogrammed with and political security discourses throughout the the capacity for satisfying and secure relationality. By 1988, with the publication of Bowlby’s final major text, Cold War. While Bowlby, along with other child psychologists, often collaborated directly with A Secure Base: Parent-Child Attachment and Healthy governmental agencies in these decades, his theories Human Development, he had distilled this focus on about childhood attachments also index a level of security even further, suggesting that childhood ideological collaboration, one that balanced the very attachments were the crucible of all future secure real insecurity of the Cold War nation state against the psychologies, adult and child alike. Through Bowlby’s new forms of psychological security being promoted attachment theories of childhood, ‘security’ moved in and promised to children as future citizen-subjects. centerstage as a major postwar psychological virtue. Put another way, in the context of the Cold War, child Not insignificantly, for Bowlby the curation of psychologies were anything but apolitical. this emotional ‘security’ was the primary job of the To see this collaboration between child psychology woman-as-mother. More than any other postwar and the state, we need look no further that one of psychoanalyst, Bowlby positioned the mother’s care Bowlby’s most influential papers from 1958, ‘The as the exclusive bulwark against what he would Nature of the Child’s Tie to His Mother’. Explaining come to describe as ‘insecure attachments’. ‘[I]t is a his understanding of the ideal, secure mother-child characteristic of a mother whose infant will develop attachment, Bowlby writes that securely,’ writes Bowlby in A Secure Base, ‘that she is continuously monitoring her infant’s state and, as ‘[I]n healthy development it is towards her [the and when he signals wanting attention, she registers mother] that each of the [infant’s] several responses his signals and acts accordingly’ (A Secure Base, 131). becomes directed, much as each of the subjects
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of the realm comes to direct his loyalty towards the Queen; and it is in relation to the mother that the several responses become integrated into the complex behavior which I have termed ‘attachment behavior’, much as it is in relation to the Sovereign that the components of our constitution become integrated into a working whole.’ (Bowlby, ‘The Child’s Tie to His Mother,’ 370, emphasis added)
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Even as Bowlby was a vocal defender of the apolitical ‘objectivity’ of scientific psychology, in this passage he nevertheless articulates the infant’s attachment behavior through a political analogy with Britain’s monarchy. Such an analogy has a double effect. In the first instance, this rhetorical flourish politicises maternal care, putting domestic maternity on the ‘right’ side of Cold War politics. Implicitly, it suggests that women ought to mother on behalf of the motherland. But at the same time, by using the vocabulary of psychological ‘health’ to talk about the organisation of political power and government, it simultaneously naturalises the Commonwealth of Nations and makes clear that UK liberal democracy is tantamount to psychological wellbeing. In his Cold War Bowlby’s attachment theory narration of the child’s attachments, Bowlby helps pronounce the extent effectively makes a case for how attachment to which the valorisation to the mother – that is, to the Queen mother of childhood psychological – is the naturalised state of security both for security is anything but the individual child and for the entire nation. separable from a global Thus, as Bowlby crafted his theories climate of insecurity about psychological normality, childhood experienced throughout the attachment, and emotional security, he did Cold War so with an eye trained on a larger Cold War climate anxious to effect security on multiple fronts. The popularity of Bowlby’s work, which promised an individualised kind of psychological security that the Western nation state could never fully guarantee, was inextricable from the context of the hyper-vigilante, security-minded West during the Key sources Cold War. But the Cold War also helped Vicedo, M. (2013). The Nature and set the very terms within which Nurture of Love: From Imprinting to Bowlby crafted his psychological Attachment in Cold War America. theories in the first place. It was University of Chicago Press. the climate through which Bowlby Webb, A. (2014). London Calling: Britain, The BBC World Service, and the Cold War. was able to substantiate and justify Bloomsbury Academic. the importance of his child-focused Hopkins, M.F., Kandiah, M.D., & Staerck psychological research. The Cold et al. (eds). (2003). Cold War Britain, War was thus inextricable not only 1945-64: New Perspectives. Palgrave from how Bowlby came to define Macmillan. childhood psychology, but also Stuart, D.T. (2008). Creating the National Security State: A History of the Law from how it was that the child’s that Transformed America. Princeton mind came to matter on such a University Press. large scale at all. This intertwining Lipschutz, R.D. (ed). (1995). On Security. of childhood psychological security Columbia University Press. and the Cold War is seen perhaps
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most clearly in a lecture Bowlby delivered in the US in 1970. Explains Bowlby:
‘Astronauts rank high as self-reliant men capable of living and working effectively in conditions of great potential danger and stress. … The performance of the crew of Apollo 13, which met with a mishap en route to the moon, is testimony to their capacity in this respect. … Turning to their life histories we find that these men ‘grew up in relatively small well-organized communities, with considerable family solidarity and strong identification with the father… During childhood, they said, they had felt with mother above everything else secure.’ (Affectional Bonds, 129-30)
With Apollo 13’s technological crisis fresh in the minds and hearts of millions of Americans, Bowlby praises US astronauts not just for their bravery, patriotism, and skill – that is, not just for their willingness to advance the West’s economic and ideological agenda in the Cold War – but interestingly for their psychological stability and emotional maturity. The fact that Bowlby’s discussion of emotional security in this passage revolves around a group of men in a profession that advanced the West’s international standing in a ‘space race’ that emblemised the Cold War is hardly insignificant. It should perhaps come as no surprise that, for Cold War psychologists, national heroes also become psychological exemplars. Yet, what is vital to recognise here is that Bowlby traces their success as astronauts back to their childhood, making clear that childhood psychology is the true foundation of political integrity. It was, Bowlby notes, these men’s experiences of maternal security that, ‘above everything else’, formed the bedrock of their exceptional contributions to national security. What Bowlby’s attachment theory thus helps pronounce is the extent to which the valorisation of childhood psychological security is anything but separable from a global climate of insecurity experienced throughout the Cold War. The prized aspects of psychological health in Bowlby’s rubric are also the prized qualities of the liberal, Western nationstate, perched precariously on the brink of nuclear war. As Bowlby writes forebodingly in his early 1946 article ‘Psychology and Democracy,’ ‘with the advent of the atomic bomb …the hope for the future lies in a far more profound understanding of the nature of the emotional forces involved and the development of scientific social techniques for modifying them.’ (76)
Through Bowlby’s theory of childhood as a site of viable, realisable security, his psychological work helped to shore up the global insecurities introduced by the Cold War.
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the psychologist july 2019 looking back
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. Organisational compassion (Liverpool)
28 June
Working successfully in private practice
28 June
The role of the psychologist in responding to youth suicide in schools
19 July
Supervision skills: Workshop 2 – Enhancing supervision skills
3 September
Expert witness: Workshop 1 – Roles, responsibilities and business
12 September
Expert witness: Workshop 2 – Writing the expert witness report for court
13 September
Supervision skills: Workshop 3 – Models of supervision
14 September
Working successfully in private practice
16 September
Writing for publication
20 September
Expert witness: Workshop 3 – Court room evidence
3 October
Expert witness: Workshop 4 – Choosing, using and presenting psychometrics in court
4 October
The application of rational emotive behavour (REBT) in sport
9 October
Creating compassionate NHS organisations
24 October
Supervision skills: Workshop 4 – Ongoing development: Supervision of supervision
2 November
Creating compassionate NHS organisations (Liverpool)
6 November
Introduction to advanced psychotherapy skills: Intensive short-term dynamic psychotherapy (ISTD)
14 November
Supervision skills: Workshop 4 – Ongoing development: Supervision of supervision
2 November
Creating compassionate NHS organisations (Liverpool)
6 November
Introduction to advanced psychotherapy skills: Intensive short-term dynamic psychotherapy (ISTD)
14 November
Working successfully in private practice
29 November
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
Follow us on Twitter: @BPSLearning #BPScpd
www.bps.org.uk/cpd
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We dip into the Society member database and pick out… Mike Eslea University of Central Lancashire One treasured possession The first thing I would grab if my office was on fire is my beautiful Japanese wooden puzzle box. It was a present from Yuichi Toda from Osaka University, who came to visit Peter K. Smith and his Social Relationships In Schools team at Sheffield, where I was doing my PhD in 1993. I had heard about the Japanese tradition of giving gifts, so I should have been better prepared. I was mortified when he gave me this wonderful box and I had nothing to offer in return, and now it sits on my shelf as a bittersweet reminder of his kindness and my bad manners. One book that everybody should read The Wisdom of Birds by Tim Birkhead. It sounds dull – it’s a history of ornithology, after all – but there’s loads in it to interest a psychologist or indeed any scientist or philosopher of science. Superb, clever, creative experiments helped discover the truth about migration, for example. Previously, people had believed that swallows spent the winter underwater, in ponds! Similarly inventive work unlocked the secrets of birdsong, enabling show-off noblemen to trick their pet nightingales into thinking it was spring, and thus make them sing on demand whatever the season.
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One historical figure who inspires me In 2005 the Psychology Department here at UCLan moved to a new building, and when it was suggested we name it after Charles Darwin I was sceptical. It sounded arrogant: I remember saying ‘imagine how we’d take the mickey if the physicists wanted theirs to be called the Einstein Building!’ but I warmed to it in the end. Then I had the idea of inviting a bigname evolutionist to do the opening ceremony on Darwin’s birthday, and was amazed when
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one on one
Richard Dawkins accepted the invitation. I even commissioned a special beer, Evolution Ale, for the occasion. Since then I have arranged Darwin Day Celebration Lectures every year, and have enjoyed some fantastic evenings with superstar scientists. Nowadays I love the fact that I work in Darwin Building. It’s an honour. One band you should go and see right now IDLES. Singer Joe Talbot says they are definitely not a punk band, but they make a powerful punky racket to go with their darkly humorous and soul-baring lyrics. Perfect music for this old punk rocker! There’s plenty for psychologists to enjoy, too: their first album is a meditation on grief, inspired by the death of Talbot’s mother; the second an examination of masculinity and fatherhood in modern Britain. With jokes. One thing I should have done more of Experiments! I have somehow ended up doing lots of work based on questionnaires and interviews, despite being happiest when doing experiments. I love the rigour of the design stage, the practical challenges of equipment building, the fun of running the participants. The research I am most proud of is the aggression paradigm I developed with my PhD student Dominik Ritter: ‘The Chopstick Game’. This gave us 15 minutes of fame, when we were asked to make a documentary for BBC3 about small men’s aggression. We spent a crazy day pitting guys as short as 4’8” against average-height controls in a variety of tasks. To my delight, the so-called Napoleon Complex turned out to be a myth. Taller men were more aggressive. One way to relax in the evening Take up archery. It’s a very inclusive sport, and also very psychological… lots in common with golf (trying to repeat the perfect shot every time) and cricket (long periods of relaxation punctuated by a few seconds of intense concentration). My club, the Chorley Bowmen, are a friendly bunch, and it’s a great way to wind down on a warm summer evening.
coming soon… shattering the self; autism; plus all our usual news, views, reviews, interviews, and much more... 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… …July 2011, aesthetics, fractals and more …Search it and so much more via www.bps.org.uk/thepsychologist psy 07_11 pOFCb2_Layout 1 20/06/2011 18:14 Page 1
the
psychologist vol 24 no 7
july 2011
Is it not beautiful? Alex Forsythe and the late Noel Sheehy look to understand art through aesthetics and fractals
Incorporating Psychologist Appointments £5 or free to members of The British Psychological Society
letters 474 news 482 careers 540 looking back 552
annual conference reports 490 how rudeness takes its toll 508 interview with Janice Haaken 512 new voices: dominant themes 550
Read more in the online version
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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, Education and Training Board Dr Juliet Foster Chair, Practice Board Alison Clarke Chair, Public Policy Board Vacant Chair, Research Board Professor Daryl O’Connor Chief Executive Sarb Bajwa Change Programme Director Diane Ashby Director of Communications Rachel Dufton (Interim) Director of Corporate Services Mike Laffan Director of Finance Harnish Hadani Director of Membership Services Annjanette Wells (Acting)
society notices Award for Equality of Opportunity 2019 See p.19 Early Career Conference Bursary Scheme See p.30 Community Psychology Festival Brighton, 13-14 September See p.43 BPS conferences and events See p.52 Cognitive & Developmental Psychology Sections Joint Conference 2019 Stoke-on-Trent, 4-6 September See p.53 Division of Occupational Psychology Annual Conference Stratford-upon-Avon, 8-10 January 2020 See p.74 CPD workshops 2019 See p.79
Director of Policy Kathryn Scott
soc
Director of Qualifications and Standards Karen Beamish (Interim)
Com Po
Governance Manager Christine Attfield 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’. The Society has offices in Belfast, Cardiff, Glasgow and London, as well as the main office in Leicester (see inside front cover for address).
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