tag:blogger.com,1999:blog-37376338901769496472024-02-21T07:20:21.922+00:00Discursive of Tunbridge WellsThe Salomons Blog
CCCU Applied Psychologyhttp://www.blogger.com/profile/12127528347937708211noreply@blogger.comBlogger60125tag:blogger.com,1999:blog-3737633890176949647.post-89235266483625812282015-11-09T14:22:00.003+00:002015-11-09T14:35:20.931+00:00We've moved!<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEh6YGQNn2D4be6FwanTzJMUr-O9Xcd2wO68NsPtYe7klN6VpVpd_Qzv3_jJv8qzmJuHqa_1CBz8xj71eQXHUpcyAzjbWF6sW8SeUEGBMo8GThgF_lKxo8hazHhCZACT78KbUJoB6v8phD0a/s1600/moving.jpg" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img border="0" height="200" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEh6YGQNn2D4be6FwanTzJMUr-O9Xcd2wO68NsPtYe7klN6VpVpd_Qzv3_jJv8qzmJuHqa_1CBz8xj71eQXHUpcyAzjbWF6sW8SeUEGBMo8GThgF_lKxo8hazHhCZACT78KbUJoB6v8phD0a/s200/moving.jpg" width="200" /></a>Please note that we've now moved Discursive of Tunbridge Wells to our university servers. All old articles and comments have been taken over too so the archive will still be available. Our new home is<br />
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<a href="https://blogs.canterbury.ac.uk/discursive/">https://blogs.canterbury.ac.uk/discursive/</a>.<br />
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We won't be posting on this site any more and comments are now closed. Please update your bookmarks accordingly.<br />
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We've already started posting on the new site with a <a href="https://blogs.canterbury.ac.uk/discursive/we-desperately-need-equality4mentalhealth-but-lets-have-services-people-actually-want-to-use/">piece</a> by on the recent campaign for equality for mental health.<br />
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Thanks to everyone who has followed us here.<br />
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<i>The Editors</i>CCCU Applied Psychologyhttp://www.blogger.com/profile/12127528347937708211noreply@blogger.com0tag:blogger.com,1999:blog-3737633890176949647.post-49181749123408251902015-09-11T12:48:00.000+01:002015-09-11T13:51:37.160+01:00What lurks beneath?<div class="MsoNormal">
<i><a href="http://discursiveoftunbridgewells.blogspot.co.uk/search/label/John%20McGowan%20%28Author%29"><span style="font-family: Georgia, Times New Roman, serif;">John McGowan</span></a></i></div>
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<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiCl8JhMzVWr9Fjy4qXJqwKAejuDuoQODo9Yx6hRFQx9ZdQhS4xe6Gj17B9JtKkFOMV_U0G4S0u9GNnBzFlVCe2Brj2Yz9gGvw_q3QBnUmdbpSasgybxX7Ng3D3GNMgfvMQcljjB6gi07H5/s1600/blue-velvet-fire-truck.jpg" imageanchor="1" style="clear: left; margin-bottom: 1em; margin-left: auto; margin-right: auto;"><img border="0" height="85" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiCl8JhMzVWr9Fjy4qXJqwKAejuDuoQODo9Yx6hRFQx9ZdQhS4xe6Gj17B9JtKkFOMV_U0G4S0u9GNnBzFlVCe2Brj2Yz9gGvw_q3QBnUmdbpSasgybxX7Ng3D3GNMgfvMQcljjB6gi07H5/s200/blue-velvet-fire-truck.jpg" width="200" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;"><span style="font-size: xx-small;">Are nice neighbourhoods all they seem?</span></td></tr>
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<span style="font-family: Georgia, Times New Roman, serif;">As those who check in regularly with this blog know we do
occasionally manage a bit of culture (<a href="http://discursiveoftunbridgewells.blogspot.co.uk/search/label/Film%20and%20TV">films</a>
and <a href="http://discursiveoftunbridgewells.blogspot.co.uk/2013/12/in-praise-of-alfie.html">books</a>), when it’s related to psychology and mental health. It’s a great pleasure
therefore, not only be able to talk about a new novel that goes into both
areas, but to interview the author.<o:p></o:p></span></div>
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<span style="font-family: Georgia, Times New Roman, serif;">Beth Miller is a novelist who used to be a psychologist
(she's got a doctorate that doesn't make it to her book covers). Her
most recent novel <i><a href="http://www.bethmiller.co.uk/tgn">The Good Neighbour</a></i> is part
domestic drama, part psychological thriller, part exploration of some scary
places in the human psyche. It starts in a nice street, in a nice town (Hove, actually), with nice neighbours. We initially see this through the eyes of
Minette, a rather bored stay-at-home mum, who makes friends with Cath: older,
feistier and coping incredibly with her son Davey’s illness. Under Cath’s
spirited influence Minette also becomes a different sort of friendly with the
hunky fellow down the road.</span></div>
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgiZrtsPDDgyL6Baz9daABd75MzqzgJ9-XOkLAOKu4Q9J7tIZNrMCY3uZjzriXFPvBCCRIajk6iMrdWmxpmkffIY8XGFbFgGGpXphrZvLkSIaWyV2WlM2Fa_SFNzV34b_WPkLFp8z5EVuYe/s1600/Good+Neighbour+cover+2.jpg" imageanchor="1" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><img border="0" height="200" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgiZrtsPDDgyL6Baz9daABd75MzqzgJ9-XOkLAOKu4Q9J7tIZNrMCY3uZjzriXFPvBCCRIajk6iMrdWmxpmkffIY8XGFbFgGGpXphrZvLkSIaWyV2WlM2Fa_SFNzV34b_WPkLFp8z5EVuYe/s200/Good+Neighbour+cover+2.jpg" width="126" /></a><span style="font-family: Georgia, Times New Roman, serif;">The job of interviewer isn't the easiest here as the story
is a craftily </span><span style="font-family: Georgia, 'Times New Roman', serif;">put together teaser where what’s going on is revealed bit by bit.
Spoiling would be bad form, but suffice to say that the niceness lasts for
about as long as the veneer in </span><i style="font-family: Georgia, 'Times New Roman', serif;"><a href="https://en.wikipedia.org/wiki/Blue_Velvet_(film)">Blue Velvet</a></i><span style="font-family: Georgia, 'Times New Roman', serif;">,
and things quickly get complicated. </span><span style="font-family: Georgia, 'Times New Roman', serif;">Beth dropped into speak to us as part of a ‘blog tour’, a
modern phenomenon that was, I </span><span style="font-family: Georgia, 'Times New Roman', serif;">confess, new to me. We’re the only
psychology/mental health blog to nab her though, and we were pleased to be able
to ask her some questions about psychology, mental health in fiction and what lies beneath nice
neighbourhoods.</span></div>
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<b><span style="font-family: Georgia, Times New Roman, serif;">You ‘used’ to be a
psychologist. Putting aside whether psychology is something you can ever truly leave
(like the Catholic Church or the Mafia), why did you end up writing fiction?<o:p></o:p></span></b></div>
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<i><span style="font-family: Georgia, Times New Roman, serif;">Because it was
something to keep me occupied while I was in the witness protection programme,
following my middle-of-the-night escape from psychology. OK, not really. I have
always written, alongside my other work, and gradually the need to write became
more pressing, until it took centre-stage and I stopped doing my other work.<o:p></o:p></span></i></div>
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<b><span style="font-family: Georgia, Times New Roman, serif;">How does your background
in psychology influence your writing?<o:p></o:p></span></b></div>
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<i><span style="font-family: Georgia, Times New Roman, serif;">I don’t consciously
use the psychology I've learned in my novels, but I think it’s there, bubbling under the surface. I guess I retain the essential curiosity that propelled me
into psychology in the first place. Like many people, I'm fascinated about what
goes on behind the public faces of complicated people. Yes, I accept that curiosity
is another word for nosiness. If I see a couple having an argument, for
instance, I really want to know what it’s about, and have been known to loiter
near them, risking their wrath, to find out. <o:p></o:p></span></i></div>
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<b><span style="font-family: Georgia, Times New Roman, serif;">One of your
characters is identified as having pretty serious mental health problems. However,
you don’t really play that ‘mentally ill’ aspect up. I wondered why if you
thought of making more of it? <o:p></o:p></span></b></div>
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<i><span style="font-family: Georgia, Times New Roman, serif;">Once you give someone
in a story a label, you create expectations about that character, which then can
limit their options. Maybe the same is true in real life? Of course, having
expectations can be very useful, in that others know, or at least think they
know, how to react to someone with a particular label. But I didn't want to direct
the reader as to how they should think and feel about this character (whom I’ll
call Chris, to save me having to type ‘this character’ every time). I didn't want it to be ‘this is a story about Chris who has X diagnosis.’ Although Chris
does have some psychological problems, I was interested not so much in the name
or origin of the problems, but more in the unique ways Chris deals with them.
In general, I think I'm interested in the unique way we all deal with our
problems, whether we call them mental health problems or not. Fiction has a
tendency to treat people with mental health problems as either unremittingly
bad, or as saintly and wise. I hope I have portrayed a more real and nuanced
person.<o:p></o:p></span></i></div>
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<i><span style="font-family: Georgia, Times New Roman, serif;">And I didn’t want it
to be an ‘issues’ book. One of the other characters says something like, just
because someone’s been diagnosed with something doesn't mean that you
necessarily understand them any better. That’s how I feel. I don’t think labels
necessarily help you understand, though they sometimes feel as if they do.<o:p></o:p></span></i></div>
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<b><span style="font-family: Georgia, Times New Roman, serif;">The Good Neighbour
explores the mundaneness of everyday life and also the terrible things that
people can sometimes do to one and other. What drew you to both types of
material?<o:p></o:p></span></b></div>
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<span style="font-family: Georgia, Times New Roman, serif;"><i>Good question! I am
very interested in the layers of extraordinariness that lie just under the
surface of everyday life. How you can just be going about your usual day and
then one new little thing happens: someone falls down the stairs, or a car
breaks down, or an unexpected letter arrives, and the whole of a person’s life
takes a different path to the one it was heading down. And I am also very
interested in the terrible things people do to each other – in fact, I'm drawn
towards exploring them out of grim fascination. I want to know why someone does
the terrible and seemingly inexplicable thing they do. Because presumably they
have reasons, however hard those might be for us to accept, and however unaware
they might be of them. It seems to me that in their different ways, psychology
and fiction are both quite useful methods for going inside a person’s head and
trying to figure out why they do what they do.</i><o:p></o:p></span></div>
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<span style="font-family: Georgia, Times New Roman, serif;"><b>Depending on whom you
talk to we’re either in one of the most </b><a href="http://www.nybooks.com/articles/archives/2014/sep/25/new-world-disorder/?pagination=false"><b>violent and scary</b></a><b> periods in human history or in one of the </b><a href="https://en.wikipedia.org/wiki/The_Better_Angels_of_Our_Nature"><b>safest</b></a><b>. Should we be worrying more about our neighbours?<o:p></o:p></b></span></div>
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<i><span style="font-family: Georgia, Times New Roman, serif;">I don’t think so. I
tend to wander round assuming people are nice until I’m proved wrong. I think
that’s at least as good a principle as assuming everyone’s awful. As the book
is called The Good neighbour, I ought to say on the record that of course all
my neighbours are lovely (though I believe some people are less lucky).<o:p></o:p></span></i></div>
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<span style="font-family: Georgia, Times New Roman, serif;">Beth Miller’s latest novel <i>The Good Neighbour </i>is published by Ebury press and is available
from a variety of outlets including <a href="http://www.amazon.co.uk/The-Good-Neighbour-Beth-Miller/dp/0091956331">this
well-known internet bookseller</a>. You can follow Beth on Twitter <a href="https://twitter.com/drbethmiller">@drbethmiller</a>. <o:p></o:p></span></div>
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CCCU Applied Psychologyhttp://www.blogger.com/profile/12127528347937708211noreply@blogger.com1tag:blogger.com,1999:blog-3737633890176949647.post-20972596401965288592015-07-14T10:15:00.003+01:002015-07-14T10:27:45.521+01:00Going beyond the norm<div class="MsoNormal">
<i><span style="font-family: Georgia, Times New Roman, serif;"><a href="http://discursiveoftunbridgewells.blogspot.co.uk/search/label/Anne%20Cooke%20%28Author%29">Anne
Cooke</a><o:p></o:p></span></i></div>
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<span style="font-family: Georgia, Times New Roman, serif;">I’ve been a bit itinerant this year. The response to <a href="http://www.understandingpsychosis.net/"><i>Understanding Psychosis and Schizophrenia</i></a><i>,</i> the report I edited for the British Psychological Society, has
been amazing and I’ve been invited to speak about it in Washington, <a href="http://www.madinamerica.com/2015/03/towards-new-understanding-psychosis-isps-2015/">New
York</a>, Seville, Dublin and most recently Milan. So it was great to get an
invitation to do something nearer home last month, in our local town of Tunbridge
Wells. I was part of a panel at the
annual <a href="http://www.criticalvoices.org.uk/">Critical Voices</a> event.
Critical Voices? To tell the truth I wasn’t totally clear about it either. It describes
itself like this: <o:p></o:p></span></div>
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<i><span style="font-family: Georgia, Times New Roman, serif;">‘The space of
medicine, health and wellbeing is one we all inhabit. It is at once complex,
often highly technical and grounded in power, politics and debate. It is a
space where we have made life changing advances. Yet it is also where we are at
our most vulnerable, where our most intimate times of birth, illness,
treatment, life and death are played out. Critical in every sense. Critical Voices provides an opportunity for
conversations that explore the voices in this space as we strive to bring
together doctors, surgeons, psychologists, patients, carers, campaigners,
researchers and academics - intertwined with the expressive insights from film,
music, poetry and literature.’<o:p></o:p></span></i></div>
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<span style="font-family: Georgia, Times New Roman, serif;">As you might expect, it was a mighty interesting day. I did a ten minute double-act with my friend
and colleague <a href="http://discursiveoftunbridgewells.blogspot.co.uk/search/label/Peter%20Kinderman%20%28Author%29">Peter
Kinderman</a>, talking about our vision for the future of psychological health
care when we stop dividing people into ‘normal’ and ‘mentally ill’. A video of the event is embeded below or you can watch it on Youtube <a href="https://www.youtube.com/watch?v=K3adesDJfBs">here</a>. </span><o:p></o:p></div>
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CCCU Applied Psychologyhttp://www.blogger.com/profile/12127528347937708211noreply@blogger.com0tag:blogger.com,1999:blog-3737633890176949647.post-29665068245171764642015-05-22T16:00:00.000+01:002015-05-23T15:35:21.537+01:00Politics, hearts and minds<div class="MsoNormal">
<i><span style="color: #222222; line-height: 107%;"><span style="font-family: Georgia, Times New Roman, serif;">In the aftermath of the
election Maggie Gibbons muses on loss, acceptance and mindfulness without navel gazing<o:p></o:p></span></span></i></div>
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<span style="font-family: Georgia, Times New Roman, serif;"><i><span style="color: #222222; line-height: 107%;">I initially wrote this
blog for </span></i><a href="https://dayinthelifemh.org.uk/"><i><span style="line-height: 107%;">https://dayinthelifemh.org.uk/</span></i></a><i><span style="color: #222222; line-height: 107%;">, a
project which clusters together the experiences of people with mental health
difficulties during four ordinary days over a year. I wrote this for 10 May
2015, sent it to a few people and it seemed to resonate. So I’ve decided to
share it more widely, with a few tweaks. It is, I stress, a very personal take.
<o:p></o:p></span></i></span></div>
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<tr><td class="tr-caption" style="text-align: center;"><span style="font-size: xx-small;">Mindfulness can help with much worse Ed</span></td></tr>
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<span style="color: #222222; line-height: 107%;"><span style="font-family: Georgia, Times New Roman, serif;">I’m
tired after weeks of hard work. I stood as an election candidate locally and
shared others’ sense of shock, anger and bewilderment at the scale of Labour’s
defeat. Coincidentally, it’s also the day before Mental Health Awareness Week.
This year the theme is mindfulness. There’s an interesting debate going on in
Buddhist, mental health and other circles about the ‘McDonaldisation’ of
mindfulness – is it becoming detached from its origins in Buddhist teachings
and practice, sold as a panacea for wider social ills and discontents, exploited
for commercial gain, a way of keeping workers compliant? And so I have been
thinking politics, hearts and minds all day.</span></span></div>
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<span style="font-family: Georgia, Times New Roman, serif;">Though
I’ve experienced, benefited from and researched mindfulness-based cognitive
therapy (MBCT), I first learned meditation - during an episode of severe
depression - from Buddhist teachers who come from a particular tradition. For
them, mindfulness goes hand in hand with a practice called metta bhavana. This
is often left untranslated, but my own working definition is ‘the development
of love and solidarity for everyone’. This is underpinned by the understanding
that we all suffer and we all wish to be free from suffering. We are encouraged,
within this practice, to open our hearts to everyone – including those we are
close to, those we find difficult and ourselves. So in metta bhavana one thing
you can say is, ‘May they be well, may they be happy, may they be free from
suffering’. <o:p></o:p></span><br />
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<span style="color: #222222; line-height: 107%;"><span style="font-family: Georgia, Times New Roman, serif;">Where,
as I understand it, mindfulness is a way of bringing gentle attention to the
thoughts running through our distracted minds, metta bhavana brings us hard up
against our feelings, emotions and moods and can offer a way of sitting with
distress and discomfort without disappearing up our solitary mental arses. <o:p></o:p></span></span></div>
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<span style="color: #222222; line-height: 107%;"><span style="font-family: Georgia, Times New Roman, serif;">My
own, hardcore experience of depression, mania, psychosis and crisis has taken
me to the outer limits of sanity and selfhood. It has taught me that I am
indeed a naked ape, and given me a full and literal definition of
‘unspeakable’. But it has also given me an insight into what it is to be
marginal, unheard and left behind – to suffer and wish to be free of suffering.
What has restored me to myself during these dark times for my soul is the persistent
and loving good humour and kindness of those who know me and can call me back
from the alien, alternative universe in which ‘I’ – as a cluster of meanings
– have become lost. <o:p></o:p></span></span></div>
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<span style="color: #222222; line-height: 107%;"><span style="font-family: Georgia, Times New Roman, serif;"><br /></span></span></div>
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<span style="color: #222222; line-height: 107%;"><span style="font-family: Georgia, Times New Roman, serif;">So
I made a decision today not to join the post-election pity party, but to try
and be a stand for consolation, solidarity and getting back to Labour’s simple
belief: ‘by the strength of the common endeavour we achieve more than we
achieve alone, so as to create for each of us the means to realise our true
potential and for all of us a community in which power, wealth and opportunity
are in the hands of the many not the few’. <o:p></o:p></span></span></div>
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<span style="color: #222222; line-height: 107%;"><span style="font-family: Georgia, Times New Roman, serif;"><br /></span></span></div>
<div class="MsoNormal">
<span style="color: #222222; line-height: 107%;"><span style="font-family: Georgia, Times New Roman, serif;">I’ve
also been chatting to left-leaning and socialist friends and we’ve been sharing
music and poetry back and forth. Someone reminded me of this extract from WH Auden’s
poem ‘<a href="http://www.poets.org/poetsorg/poem/september-1-1939">September
1, 1939</a>’, written at the beginning of World War II: <o:p></o:p></span></span></div>
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<span style="color: #222222; line-height: 107%;"><span style="font-family: Georgia, Times New Roman, serif;"><br /></span></span></div>
<div class="MsoNormal">
<span style="color: #222222; line-height: 107%;"><span style="font-family: Georgia, Times New Roman, serif;">Defenceless
under the night</span></span></div>
<span style="font-family: Georgia, Times New Roman, serif;"><span style="color: #222222; line-height: 107%;">
Our world in stupor lies;</span><span style="color: #222222; line-height: 107%;"> </span></span><br />
<span style="font-family: Georgia, Times New Roman, serif;"><span style="color: #222222; line-height: 107%;">Yet, dotted everywhere,</span><span style="color: #222222; line-height: 107%;"> </span></span><br />
<span style="font-family: Georgia, Times New Roman, serif;"><span style="color: #222222; line-height: 107%;">Ironic points of light</span><span style="color: #222222; line-height: 107%;"> </span></span><br />
<span style="font-family: Georgia, Times New Roman, serif;"><span style="color: #222222; line-height: 107%;">Flash out wherever the Just</span><span style="color: #222222; line-height: 107%;"> </span></span><br />
<span style="font-family: Georgia, Times New Roman, serif;"><span style="color: #222222; line-height: 107%;">Exchange their messages:</span><span style="color: #222222; line-height: 107%;"> </span></span><br />
<span style="font-family: Georgia, Times New Roman, serif;"><span style="color: #222222; line-height: 107%;">May I, composed like them</span><span style="color: #222222; line-height: 107%;"> </span></span><br />
<span style="font-family: Georgia, Times New Roman, serif;"><span style="color: #222222; line-height: 107%;">Of Eros and of dust,</span><span style="color: #222222; line-height: 107%;"> </span></span><br />
<span style="font-family: Georgia, Times New Roman, serif;"><span style="color: #222222; line-height: 107%;">Beleaguered by the same</span><span style="color: #222222; line-height: 107%;"> </span></span><br />
<span style="font-family: Georgia, Times New Roman, serif;"><span style="color: #222222; line-height: 107%;">Negation and despair,</span><span style="color: #222222; line-height: 107%;"> </span></span><br />
<span style="font-family: Georgia, Times New Roman, serif;"><span style="color: #222222; line-height: 107%;">Show an affirming flame.*</span></span><br />
<br />
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<span style="font-family: Georgia, Times New Roman, serif;"><span style="color: #222222; line-height: 107%;">I’ll
be trying to show others an affirming flame over the coming months. Will they
respond? No idea and don’t mind, but hope so. </span><o:p></o:p></span></div>
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<span style="color: #222222; line-height: 107%;"><span style="font-family: Georgia, Times New Roman, serif;"><br /></span></span></div>
<div class="MsoNormal">
<span style="font-family: Georgia, Times New Roman, serif;"><span style="color: #222222; line-height: 107%;"><i>You can follow Maggie on Twitter </i></span><a class="ProfileHeaderCard-screennameLink u-linkComplex js-nav" href="https://twitter.com/pegpirate" style="background: rgb(245, 248, 250); line-height: 14px; text-decoration: none !important;"><span style="color: black;"><i>@<span class="u-linkComplex-target">pegpirate</span></i></span></a></span><br />
<br />
<span style="font-family: Georgia, Times New Roman, serif;"><span style="color: black;">*<i>Note: The Auden poem originally appeared without line breaks. This has now been remedied and I'd like to add apologies to the spirits of Auden and Yeats (on whose verse the poem was originally based). Ed. <span class="u-linkComplex-target"> </span></i></span></span></div>
CCCU Applied Psychologyhttp://www.blogger.com/profile/12127528347937708211noreply@blogger.com0tag:blogger.com,1999:blog-3737633890176949647.post-74189030346300025052015-04-24T17:32:00.001+01:002015-04-24T17:32:56.466+01:00Cognitive impairment and voting: the capacity to be heard<div class="MsoNormal">
<i><span style="font-family: Georgia, Times New Roman, serif;">Alexandra Richards<o:p></o:p></span></i></div>
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<i><span style="font-family: Georgia, Times New Roman, serif;"><br /></span></i></div>
<table cellpadding="0" cellspacing="0" class="tr-caption-container" style="float: left; margin-right: 1em; text-align: left;"><tbody>
<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEh1M92gYlXjyP6nA1mjWGFlRWWIxo48Tu007lUlP5cgZp07VZE9msm__CurZGWKWE1lAGuGYslGqt_R1kmORt32JduD8In73eWja3biY_xtAyq6fbtbdiHwWUqU0IVb1iJXwMDyPpkIr_jQ/s1600/Why-do-we-vote-democracy1-236x236.jpg" imageanchor="1" style="clear: left; margin-bottom: 1em; margin-left: auto; margin-right: auto;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEh1M92gYlXjyP6nA1mjWGFlRWWIxo48Tu007lUlP5cgZp07VZE9msm__CurZGWKWE1lAGuGYslGqt_R1kmORt32JduD8In73eWja3biY_xtAyq6fbtbdiHwWUqU0IVb1iJXwMDyPpkIr_jQ/s1600/Why-do-we-vote-democracy1-236x236.jpg" height="200" width="200" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;"><span style="font-size: xx-small;">Who gets to Vote?<br />Image: <a href="http://www.everyvotecounts.org.uk/voting/why-do-we-vote/">Every Vote Counts</a></span></td></tr>
</tbody></table>
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<span style="font-family: Georgia, Times New Roman, serif;">The upcoming
election is an opportunity for the population to have their say in the future
running of the country. We live in a democracy and the right to vote feels
fundamental. But <a href="http://www.everyvotecounts.org.uk/information-for-politicians/why-is-it-important">two
thirds</a> of all people in the UK with learning disabilities do not vote. Many
may not even know that they are entitled to a vote. UK-based statistics are not
available but research suggests that for individuals who have cognitive
impairments of other causes (e.g dementia, brain injury), <a href="http://www.neurology.org/content/60/9/1546?ijkey=ac80b683320948ed3e8c5574caab4e9649acf4b4&keytype2=tf_ipsecsha%20,%20http://online.liebertpub.com/doi/abs/10.1089/elj.2011.0121%20http://www.tandfonline.com/doi/abs/10.1080/08959420.2015.969090#.VTPv1_mjNcY">voting
rates</a> may be similarly low. <o:p></o:p></span></div>
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<br /></div>
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<span style="font-family: Georgia, Times New Roman, serif;">Though there
are many jokes about the intellectual functioning of the average voter abound
in the run-up to an election, the reality is that voting eligibility is not
determined by intellectual ability. It appears though that this is not common
knowledge. Many health and social care professionals (see <a href="http://rps.sagepub.com/content/38/1/58.abstract">here </a>and <a href="http://rps.sagepub.com/content/38/1/58.abstract">here</a>) are not fully
aware that their clients are actually allowed to vote. The presence of a cognitive impairment may
make the process of voting challenging, but is this really sufficient reason to
not support people from doing so? Assumptions about whether someone can and
should vote may be informed by the ideas around their <a href="https://thesmallplaces.wordpress.com/2014/09/24/spread-the-word-you-dont-need-mental-capacity-to-vote/">mental
capacity</a>.</span></div>
<a name='more'></a><span style="font-family: Georgia, Times New Roman, serif;"><span style="background: white; color: #222222;"><o:p></o:p></span></span><br />
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<span style="font-family: Georgia, 'Times New Roman', serif;">The </span><a href="https://www.gov.uk/government/collections/mental-capacity-act-making-decisions" style="font-family: Georgia, 'Times New Roman', serif;">Mental
Capacity Act</a><span style="font-family: Georgia, 'Times New Roman', serif;"> (2005) supports adults who have an ‘impairment of or disturbance
in the functioning of mind or brain’, who may lack the ability to make a
decision. Capacity is assessed on an individual decision-basis, and with all
available support the individual must demonstrate that they can do the
following:</span></div>
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<span style="font-family: Georgia, Times New Roman, serif;"><br /></span></div>
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</div>
<ul>
<li><span style="font-family: Georgia, 'Times New Roman', serif;">Understand
the relevant information, including understanding the likely consequences of
making the decision.</span></li>
<li><span style="font-family: Georgia, 'Times New Roman', serif;">Retain that
information.</span></li>
<li><span style="font-family: Georgia, 'Times New Roman', serif;">Use or weigh
that information as part of making the decision.</span></li>
<li><span style="font-family: Georgia, 'Times New Roman', serif;">Communicate
their decision. </span></li>
</ul>
<br />
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<span style="font-family: Georgia, Times New Roman, serif;">At face-value,
the notion of assessing capacity to vote appears sensible. But when one
considers how we might judge ability to ‘understand and retain’ the information
relevant to the decision to vote, the process is not straightforward. Which
information is most relevant? Would we expect someone to have read all of the party
manifestos and to be able to recall this information? How would we expect
someone to explain the ‘likely consequences’ of their voting choice? We
certainly do not apply these criteria to people without disabilities and I
imagine few could fulfil this criteria. <o:p></o:p></span></div>
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<span style="font-family: Georgia, Times New Roman, serif;"><br /></span></div>
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<span style="font-family: Georgia, Times New Roman, serif;">The available
advice around voting capacity is often lacking or conflicting. The Mental
Capacity Act explicitly <a href="http://www.amcat.org.uk/excluded_decisions/">does
not cover voting</a>. It is however relevant
to the decision of appointing a proxy. Intellectual functioning is not
mentioned in the voting eligibility criteria set out by <a href="https://www.gov.uk/voting-in-the-uk/general-elections">Government </a>services
or the <a href="http://www.electoralcommission.org.uk/faq/voting-and-registration/who-is-eligible-to-vote-at-a-uk-general-election">Electoral
Commission</a>. The latter <a href="http://www.parliament.uk/documents/commons/lib/research/briefings/snpc-02208.pdf">considers that</a> votes must
not be subject to any legal incapacity to vote’, and that ‘A lack of mental capacity is not a
legal incapacity to vote’. The <a href="http://www.legislation.gov.uk/ukpga/2006/22/part/8/crossheading/legal-incapacity-to-vote">legal position</a> from 2006
has been that ‘a person is subject to a legal incapacity to vote by reason of
his mental state’ was abolished. On the other hand information provided by the
Citizen’s Advice Bureau states that ‘people who
have a severe mental illness and are unable to understand the voting procedure<span style="color: #353535;">’ </span>are ineligible to vote. An <a href="http://www.bmj.com/content/341/bmj.c4085.full#ref-12">editorial</a> in the
British Medical Journal suggested ‘it seems inevitable that doctors will be asked
to assess capacity to vote’ and expressed the need for advice. It may be
necessary for voting information to explicitly state that a cognitive impairment
does not preclude someone from voting to dispel eligibility myths. <o:p></o:p></span></div>
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<span style="font-family: Georgia, Times New Roman, serif;"><br /></span></div>
<div class="MsoNormal">
<span style="font-family: Georgia, Times New Roman, serif;">My own experiences of working within a rehabilitation service for adults
with acquired brain injury has highlighted to me the lack of awareness around
voting eligibility and also issues of accessibility. Many of the service-users
have significant cognitive impairments as well as communication and sensory difficulties.
Our attention was drawn to the issue at the start of the year, at which point
none of the residents where I work were actually registered to vote. Whilst all
staff are committed to supporting social inclusion, we realised we had never
considered voting as part of this. Inquiries to local candidates requesting
clarification on eligibility and accessible information generated no responses.
After informing ourselves of some of the information above, we made service-users
aware of the election and their right to vote. For those interested, we have
supported them to register. For many of the service-users, who are grappling
with the consequences of their brain injury, the election does not appear to be
a particular priority. However I do see it as within our remit, as
professionals who seek to empower, to make the people we support aware of their
rights and to actively promote these. I have been surprised by local
politicians’ lack of interest in engaging with our service-users, who in
addition to being a marginalised group, are also “untapped” voters. Whilst most
people complain about the amount of election material they receive through
their door, we have yet to receive any unsolicited information.<o:p></o:p></span></div>
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<span style="font-family: Georgia, Times New Roman, serif;"><br /></span></div>
<div class="MsoNormal">
<span style="font-family: Georgia, Times New Roman, serif;">Given that people
who have a cognitive impairment are legally entitled to vote, how can we assist
them to understand and be involved in the process of voting? We need to promote
voting, whilst also ensuring that individuals are not unduly influenced or
exploited by others. <a href="http://www.everyvotecounts.org.uk/information-for-politicians/why-is-it-important">Every
Vote Counts</a> campaigns to increase the rates at which people with learning
disabilities are voting and encourages political parties to take note. At the
time of writing the <a href="https://d3n8a8pro7vhmx.cloudfront.net/libdems/pages/8907/attachments/original/1429028136/Liberal-Democrat_Manifesto-_2015-Easy-Read.pdf?1429028136">Liberal
Democrats</a> and the <a href="https://www.greenparty.org.uk/assets/files/manifesto/Easy_Read_Green_Party_2015_General_Election_Manifesto.pdf">Green
Party</a> have released easy read
accessible manifestos. Dementia-related organisations have also produced some
advice regarding voting (see <a href="http://alzheimers.org.uk/site/scripts/documents_info.php?documentID=1362">here</a>
and <a href="http://www.alzscot.org/news_and_community/news/3150_faq_about_voting_and_dementia">here</a>).<o:p></o:p></span></div>
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<span style="font-family: Georgia, Times New Roman, serif;"><br /></span></div>
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<span style="font-family: Georgia, Times New Roman, serif;">More however
needs to be done. The lack of awareness around voting eligibility represents
one of the many ways that people with disabilities are unconsidered and
alienated within our society. As frequent users of health and social care
services, people with disabilities deserve the right to contribute to decision
making that may have a considerable impact on them. If politics appears too abstruse for someone
with a cognitive impairment to follow, then this is a fault for political parties
to address. Voting is not a matter of intellectual ability but of civil rights
and we must promote inclusion for all. <o:p></o:p></span></div>
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<span style="font-family: Georgia, Times New Roman, serif;"><br /></span></div>
<br />
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<i><span style="font-family: Georgia, Times New Roman, serif;">Dr Alexandra Richards is a clinical
psychologist working in neurorehabilitation. You can follow her on Twitter <a href="https://twitter.com/allyfrichards">@allyfrichards</a>.</span><span style="font-family: Arial, sans-serif;"><o:p></o:p></span></i></div>
CCCU Applied Psychologyhttp://www.blogger.com/profile/12127528347937708211noreply@blogger.com0tag:blogger.com,1999:blog-3737633890176949647.post-60737048107615321372015-04-02T16:47:00.001+01:002015-04-02T17:04:51.344+01:00Me, my brain and baked beans<div class="MsoNormal">
<i><span style="font-family: Georgia, Times New Roman, serif;">Today, in the first in
an occasional series of longer form pieces, <a href="http://discursiveoftunbridgewells.blogspot.co.uk/search/label/Peter%20Kinderman%20%28Author%29">Peter
Kinderman</a> reflects on the interaction between his genetic inheritance and
his personal experience, and considers what they mean for his own mental
health. </span></i></div>
<div class="MsoNormal">
<br /></div>
<table cellpadding="0" cellspacing="0" class="tr-caption-container" style="float: left; margin-right: 1em; text-align: left;"><tbody>
<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgQnZKshzf7v_NJDqpeKa4KQWcGGxrUKORXlTDIIsEKB-_KLZG7UufDoLyXneU0RmhAnTNJncAmWYeRcWwQea-Bj4Vi7nBOMeImNrloUKWUnH1rQHRNi70zQ8F10SgRvFswWs5C3sHj9kwz/s1600/beans_on_toast430x300.jpg" imageanchor="1" style="clear: left; margin-bottom: 1em; margin-left: auto; margin-right: auto;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgQnZKshzf7v_NJDqpeKa4KQWcGGxrUKORXlTDIIsEKB-_KLZG7UufDoLyXneU0RmhAnTNJncAmWYeRcWwQea-Bj4Vi7nBOMeImNrloUKWUnH1rQHRNi70zQ8F10SgRvFswWs5C3sHj9kwz/s1600/beans_on_toast430x300.jpg" height="139" width="200" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;"><span style="font-family: Georgia, 'Times New Roman', serif; text-align: start;"><span style="font-size: xx-small;">‘Very nice dear, now, do you want </span></span><br />
<span style="font-family: Georgia, 'Times New Roman', serif; text-align: start;"><span style="font-size: xx-small;">baked beans on toast for breakfast?’ </span></span></td></tr>
</tbody></table>
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<span style="font-family: Georgia, Times New Roman, serif;">My
wife once came with me on a Saturday morning visit to a psychiatric hospital. I
was collecting data for my PhD, and she met me in the car park of a large
psychiatric hospital after I’d conducted my interviews. As I drove away, she stroked the back of my
hand and suggested that I could relax my knuckle-whitening grip on the steering
wheel. I really didn’t like leaving the residents behind. I wanted to rescue
them.</span></div>
<a name='more'></a><span style="font-family: Georgia, Times New Roman, serif;"><o:p></o:p></span><br />
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span style="font-family: Georgia, Times New Roman, serif;">In
mental health, resolving the relative contributions of our biology and genetics
and how these interact with social and environmental factors (our parenting,
peer-relationships, learning, and experiences of both abuse and nurturing) is
more than an intellectual puzzle. I’m occasionally annoyed by what appears to
be a rather simplistic suggestion that, if there’s a biological, even
heritable, element, to a psychological phenomenon, then we’re inevitably
discussing an illness, a disease. Of course there are biological elements in
every behaviour, thought emotion, or trait, since they all involve our brains.
We don’t, despite the jokes, think using any other organ and we do, despite the
jokes, always use our brain when we’re thinking. But our attitudes to these
issues also have direct personal implications. As a mental health professional,
as a some-time user of mental health services and (like most of us) as someone
with family members with more serious mental health problems, it’s certainly
personal for me. </span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span style="font-family: Georgia, Times New Roman, serif;">I’ve
spent much of my professional life studying psychological aspects of mental
health problems. Inevitably, this has also meant discussing the role of
biology. I hope I’ve made some progress in understanding these issues, in working
out how the two <a href="http://www.amazon.com/The-New-Laws-Psychology-Behaviour/dp/1780336004/">relate
to each other</a>, and the <a href="http://www.amazon.com/Prescription-Psychiatry-Approach-Mental-Wellbeing/dp/1137408707/">implications
for services</a>. That’s my academic day-job. But it’s not just academic for me.
I’m probably not untypical of most people reading this; I can see clear
examples of how my experiences may have affected my own mental health, but I
can also see reasons to suspect biological, heritable, traits. As in all
aspects of human behaviour, both nature and nurture are involved and they have
been intimately entwined in a<span class="apple-converted-space"><span style="color: #383838;"> </span></span><a href="http://www.nature.com/nature/journal/v468/n7321/full/nature09563.html"><span style="color: #557585; mso-bidi-font-weight: bold;">complex interactive dance</span></a><span style="color: #383838;"> </span>throughout my life.<o:p></o:p></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span style="font-family: Georgia, Times New Roman, serif;">I
need to be cautious, because I don't want to say anything that will irritate my
siblings, but I do think there were oddities in my upbringing. My parents had
very strong religious beliefs, and I think it’s fair to say that, in addition, there
was a degree of emotional repression. Our family relationships were somewhat
complicated. Just one example: my parents’ belief system included the need to
love God more than anything or anyone else, including one’s children. So, after
my mother’s death, we discovered that, when she had confessed to a religious
mentor that she was in danger of loving her children more than God, there was a
subsequent process of re-adjustment. She was encouraged to practice loving her
children less. My parents rejected the material world as merely a
stepping-stone on the way to heaven (or hell) and paid little attention to worldly
pursuits. I remember opening a letter from Cambridge University confirming an
offer of a place as an undergraduate. I told my mother, whose reply was; ‘Very
nice dear, now, do you want baked beans on toast for breakfast?’ Pride was a
very worldly emotion. I guess that experiences like that must have had an
effect on me and on my siblings.<o:p></o:p></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span style="font-family: Georgia, Times New Roman, serif;">So
much for my upbringing. But like all of us, I was also born with a particular brain.
I’ve been educated to observe signs of neurological as well as psychological
functioning (if those two concepts can be separated). And one of my close
relatives has had major mental health problems throughout his (and therefore
my) life. So it’s intriguing to observe similarities between us and speculate
on their origin. Do we behave similarly because of our shared upbringing, our
shared genetic heritage or (of course) both? <i><o:p></o:p></i></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<i><span style="font-family: Georgia, Times New Roman, serif;">A phenotype<o:p></o:p></span></i></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span style="font-family: Georgia, Times New Roman, serif;">So
I am emotionally labile. My self-esteem and emotions are very fragile and very
much dependent on what I imagine other people are thinking. Or, at least, I
think I am; my observations of my own behaviour are themselves subjective, and
it’s possible that others do these things as much as I do. I frighten myself
(given my relative’s experiences) by fantasising about winning Nobel Prizes,
winning Pulitzer prizes, being elected to this and that, being awarded
knighthoods. And that <i>is</i> frightening
because I’ve seen self-referent fantasies ruin other people’s lives. My
selective attention is terrible and I find it difficult to avoid distractions.
Those who know me well will know that I work with the BBC rolling news
constantly running in the background, and I frequently play games while on the
phone. I appear to have problems with face-recognition; I find it almost
impossible even to recognise the faces of people whom I know well. And when in
conversation with people (in what seems to me to be a potentially related
phenomenon), I find it difficult maintain eye-contact, and look to the side to
line-up images in the distance. And, perhaps most saliently, I lurch forwards
and jump to conclusions in my mental logic. So, if you give me the sequence ‘A,
B, C…’ and ask me to complete the sequence, I’ll say Z. Maybe that’s a bit of a
joke (a pun on ‘complete’), and it’s unequivocally good for me in my academic
career. A creative professor is a good professor. I also and simultaneously
make abstract and surreal connections. It’s a recognised part of my teaching style
- I’ll veer off on a tangent. Again, perhaps useful in an academic and possibly
engaging or at least entertaining for students (if they can keep up…). But <a href="http://en.wikipedia.org/wiki/Jumping_to_conclusions">jumping to
conclusions</a>, <a href="http://en.wikipedia.org/wiki/Derailment_%28thought_disorder%29">tangential
connectivity</a> and abstract, ‘<a href="http://en.wikipedia.org/wiki/Clanging">clang</a>’
associations all have very interesting connotations in the field of mental
health.<o:p></o:p></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span style="font-family: Georgia, Times New Roman, serif;">So
I am very interested, and I hope I’m open-minded, about what it is, if
anything, that we inherit. How do I differ from other people? What proportion
of the variance in these traits can be accounted for by genetic differences? What
proportion of the variance in these traits comes from being brought up by
repressed religious extremists? What proportion comes from being reinforced,
through my childhood, for being academic? Which elements of my upbringing were
different other people’s anyway?<span lang="EN-US"><o:p></o:p></span></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<i><span style="font-family: Georgia, Times New Roman, serif;">Gene x environment
interactions<o:p></o:p></span></i></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span style="font-family: Georgia, Times New Roman, serif;">My
tentative conclusions, as of today, are these: First, my childhood had many
oddities and peculiarities that would capture the attention of any competent
psychotherapist. Second, I believe that my professional eye has identified
interesting <a href="http://en.wikipedia.org/wiki/Phenotype">phenotypes</a> in
my close family that reflect potentially heritable traits. Third, these traits
may well put me at risk of many emotional problems. Incidentally, they may well
also make me absolute hell to live with, and I must give credit to those who
have given that a go. Fourth, the interactions of these heritable and
environmental factors in my development have also created a person – me – that
I value and respect. That’s a very odd, solipsistic, thing to say, but it’s
important. <o:p></o:p></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span style="font-family: Georgia, Times New Roman, serif;">Which
leads to my fifth and most important conclusion. For some people, such as for
my relatives, these interactions cause problems. For others, like me, a
presumably very similar pattern of interactions has observable similarities but
different outcomes. Of course we need to consider the contribution of
biological as well as environmental factors in our psychological makeup. I
think it’s perfectly possible to be intelligent and open-minded about the contribution
of genetic and environmental factors in our mental health. We can intelligently
and respectfully discuss how experiences and heritable traits can interact to
produce the wonderful variety of human experience. This, I think, is a much
more accurate and helpful way to conceptualise what’s going on than to say that
some of us – but only some of us - have ‘mental illnesses’. Labels such as
‘schizophrenia’ not only suffer from the validity problems that we’ve discussed
<a href="http://www.bps.org.uk/networks-and-communities/member-microsite/division-clinical-psychology/understanding-psychosis-and-schizophrenia">elsewhere</a>,
but also obfuscate these important considerations. I don't think it’s helpful
to consider how I have managed to avoid developing ‘schizophrenia’, or whether
I have ‘attenuated psychosis syndrome’. To do that, to reduce these discussions
to binary considerations of the presence or absence of disorders, necessarily
constrains the scientific debate. It can
also sometimes have frightening consequences in the real world. When I’ve
mentioned some of these issues before in less public settings, friends and
colleagues have often told me that I’m being brave, and that it’s a potentially
risky topic of conversation. So why might that be? <o:p></o:p></span></div>
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<div class="MsoNormal">
<i><span style="font-family: Georgia, Times New Roman, serif;">The eradication of
undesirable genetic traits<o:p></o:p></span></i></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span style="font-family: Georgia, Times New Roman, serif;">Part
of the reason that people might be reluctant to talk about such issues is that
we have a very poor track record in this area. This is a difficult topic, but I
think it is important to remember the infamous 1933 Nazi Law for the <a href="http://en.wikipedia.org/wiki/Law_for_the_Prevention_of_Hereditarily_Diseased_Offspring">Prevention
of Genetically Diseased Offspring</a> (Gesetz zur Verhütung erbkranken
Nachwuchses). Arguments of <a href="http://schizophreniabulletin.oxfordjournals.org/content/36/1/26.full">genetic
science</a> not only led to the drafting of this law (which permitted the
compulsory sterilisation of any citizens who were judged to possess a ‘genetic
disorder’ which could be passed onto their children) but indeed led German-American
psychiatrist <a href="http://en.wikipedia.org/wiki/Franz_Josef_Kallmann">Franz
Kallmann</a> to argue that such a policy of sterilisation should be extended to
the relatives of people with mental health problems (in order to eradicate the
genes supposedly responsible). The notorious <a href="http://en.wikipedia.org/wiki/Action_T4">Action T4</a> ‘eradication’
programme was the logical extension of these policies.<o:p></o:p></span></div>
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<div class="MsoNormal">
<span style="font-family: Georgia, Times New Roman, serif;"></span></div>
<div class="separator" style="clear: both; text-align: center;">
</div>
<table cellpadding="0" cellspacing="0" class="tr-caption-container" style="float: right; margin-left: 1em; text-align: right;"><tbody>
<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg3mCUud92gHLadRNvLlexmRwWxuuU7zUqtWcKPQL9HLOYBTbxuWBoxrr1QDfzXf2FNuXXAtsMr5UwR4ROjenP166os7IcPOaqmL0rKudDm1CZA4wGDUJJqC_9HrgTttztazxrYcJrnANBj/s1600/Nazi+3.jpg" imageanchor="1" style="clear: right; margin-bottom: 1em; margin-left: auto; margin-right: auto;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg3mCUud92gHLadRNvLlexmRwWxuuU7zUqtWcKPQL9HLOYBTbxuWBoxrr1QDfzXf2FNuXXAtsMr5UwR4ROjenP166os7IcPOaqmL0rKudDm1CZA4wGDUJJqC_9HrgTttztazxrYcJrnANBj/s1600/Nazi+3.jpg" height="223" width="320" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;"><span style="font-size: xx-small;"><i style="text-align: start;">On the left, the </i><a href="http://en.wikipedia.org/wiki/Law_for_the_Prevention_of_Hereditarily_Diseased_Offspring" style="text-align: start;"><i>Reich Law Gazette on 25 July 1933: Law for the Prevention <br />of Genetically Diseased Offspring</i></a><i style="text-align: start;">; on the right, Adolf Hitler’s order <br />for the </i><a href="http://en.wikipedia.org/wiki/Action_T4" style="text-align: start;"><i>Action T4</i></a><i style="text-align: start;"> programme.</i></span></td></tr>
</tbody></table>
<span style="font-family: Georgia, 'Times New Roman', serif;">Of
course, a focus on biological aspects of mental health problems is not in any
sense necessarily synonymous with fascism. But for many of us, there are echoes
of blame, of stigma, when we identify the pathology within the genetic
substrate of the person. I’m reminded of Eric Pickles’ notorious throw-away
comment to a voter campaigning about the abuse she’d experienced that she
should “</span><a href="http://www.bbc.co.uk/news/uk-politics-24324556" style="font-family: Georgia, 'Times New Roman', serif;">adjust her
medication”</a><span style="font-family: Georgia, 'Times New Roman', serif;">. If the pathology lies in the person, and particularly if it is
a biological problem, we can dismiss any further troubling considerations.</span><br />
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span style="font-family: Georgia, Times New Roman, serif;">So
one way to understand these kinds of experiences is to diagnose some form of
subclinical syndrome; perhaps <a href="http://www.ncbi.nlm.nih.gov/pubmed/23773295">attenuated psychosis</a>. <span lang="EN-US">If the Nazis had won the Second World War, I would have been castrated
as a first-degree relative of a ‘schizophrenic’. Disease-model, eugenic,
thinking is a direct threat to me personally, especially given the recent rise
of far-right parties in Europe. I am interested in whether the traits that make
me a good professor may also be related to the traits I listed earlier, and on
their impact on my emotions. I am interested in whether they may have emerged
from a similar mix of genes and environment that led my relative to experience
psychosis. I am very interested in the practical implications; I have always,
for example, avoided certain classes of street drugs. </span>It is absolutely
possible to discuss gene × environment
interactions, but – please – don't use the ‘disease-model’ as a framework.<o:p></o:p></span></div>
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<br /></div>
<div class="MsoNormal">
<span lang="EN-US"><span style="font-family: Georgia, Times New Roman, serif;">Acknowledgement: Thanks to Anne Cooke for helpful
comments and advice on earlier drafts.<o:p></o:p></span></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span style="font-family: Georgia, Times New Roman, serif;"><i><span lang="EN-US">Peter Kinderman is Professor of Clinical Psychology at the University of
Liverpool. You can follow him on Twitter <a href="https://twitter.com/peterkinderman">here</a>. A <a href="https://theconversation.com/mental-health-is-a-complex-interactive-dance-of-nature-and-nurture-38003">shorter
version</a> of this piece originally appeared on The Conversation UK.</span></i><i><o:p></o:p></i></span></div>
<br />
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CCCU Applied Psychologyhttp://www.blogger.com/profile/12127528347937708211noreply@blogger.com4tag:blogger.com,1999:blog-3737633890176949647.post-18408209391176562142015-04-01T09:51:00.002+01:002015-05-28T11:34:23.415+01:00Is supporting populist political parties a mental disorder?<!--[if gte mso 9]><xml>
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<div class="MsoNormal">
<i style="font-family: Georgia, 'Times New Roman', serif;"><a href="http://discursiveoftunbridgewells.blogspot.co.uk/search/label/John%20McGowan%20%28Author%29">John McGowan</a> makes the case</i></div>
<br />
<span style="font-size: small;"><span style="font-family: Georgia,"Times New Roman",serif;"><span style="background-color: #f3f3f3;">
</span></span></span><br />
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<tr><td style="text-align: center;"><span style="font-size: small;"><span style="font-family: Georgia,"Times New Roman",serif;"><span style="background-color: #f3f3f3;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgKi-6bc1hKTD-sHkW1msXNmXNrXcJCHkB16IWHEJwtKhkAEJIZoz0wt33lbEWAV9ohHez9YhFBBxfYjzxN5b2d5iz3I5RAX0-0I4jqb5ottXRixoGMSX7VurzhVbR1UZYHS3ASIUvh4eVI/s1600/Russell_Brand_Fire_Brigades_Union_interview.jpg" imageanchor="1" style="clear: left; margin-bottom: 1em; margin-left: auto; margin-right: auto;"><img border="0" height="133" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgKi-6bc1hKTD-sHkW1msXNmXNrXcJCHkB16IWHEJwtKhkAEJIZoz0wt33lbEWAV9ohHez9YhFBBxfYjzxN5b2d5iz3I5RAX0-0I4jqb5ottXRixoGMSX7VurzhVbR1UZYHS3ASIUvh4eVI/s1600/Russell_Brand_Fire_Brigades_Union_interview.jpg" width="200" /></a></span></span></span></td></tr>
<tr><td class="tr-caption" style="text-align: center;"><span style="font-size: small;"><span style="font-family: Georgia,"Times New Roman",serif;"><span style="background-color: #f3f3f3;"><span style="font-size: xx-small;">Commitment? Or sign of illness?</span></span></span></span></td></tr>
</tbody></table>
<div class="MsoNormal">
<span style="font-size: small;"><span style="font-family: Georgia,"Times New Roman",serif;"><span style="background-color: #f3f3f3;"><span style="line-height: 107%;">It’s just over a month until the
UK general election and many Brits seem to have lost trust in their traditional
politicos. Whether it’s the UK Independence Party (UKIP) scapegoating the
European Union and immigrants, a rise in nationalism (the Scottish National
party), or Russell Brand’s teenage
anarchism, faith in facile, and sometimes ugly, solutions is on the march. <span style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto;">It’s a huge relief,
therefore, to hear that the editors of the DSM (the main reference book for
psychiatric classification), are considering a new category of disorder to
cover this condition. Clearly </span></span><a href="http://discursiveoftunbridgewells.blogspot.co.uk/search/label/Psychiatric%20Diagnosis"><span style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 107%;">many critical things have been said</span></a><span style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 107%;"> about the burgeoning amount of psychiatric
diagnosis, here and elsewhere. However, I’ve just looked at the DSM draft entry
(reproduced below), and think that this time, the American Psychiatric
Association might really be onto something. In fact, all I can say is bring it
on. </span></span></span></span></div>
<a name='more'></a><div class="MsoNormal">
<br /></div>
<span style="font-size: small;"><span style="font-family: Georgia,"Times New Roman",serif;"><span style="background-color: #f3f3f3;">
</span></span></span><br />
<div class="MsoNormal">
<span style="font-size: small;"><span style="font-family: Georgia,"Times New Roman",serif;"><span style="background-color: #f3f3f3;"><i><b><span style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 107%;">Populist Politics Disorder (Draft for
consultation)</span></b></i></span></span></span></div>
<div class="MsoNormal">
<br /></div>
<span style="font-size: small;"><span style="font-family: Georgia,"Times New Roman",serif;"><span style="background-color: #f3f3f3;"><i>
</i></span></span></span><br />
<div class="MsoNormal">
<span style="font-size: small;"><span style="font-family: Georgia,"Times New Roman",serif;"><span style="background-color: #f3f3f3;"><i><span style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 107%;">A disorder
characterised by a passionate, often recently acquired, belief in populist
political parties and/or broad and ill-defined solutions to complex social and
economic problems. This can last anything from two weeks to several years.
Sometimes it may persist for life. Manifestations include pompous and
self-righteous discourse in conversations, social media exchanges and car
stickers. As well as the cardinal symptoms outlined above, a number of other signs
may characterise the presentation:</span></i></span></span></span></div>
<div class="MsoNormal">
<br /></div>
<span style="font-size: small;"><span style="font-family: Georgia,"Times New Roman",serif;"><span style="background-color: #f3f3f3;"><i>
</i></span></span></span><br />
<div class="MsoNormal" style="margin-left: 2cm;">
<i><span style="font-family: Georgia,"Times New Roman",serif;"><span style="font-size: small;"><span style="background-color: #f3f3f3;"><span style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 107%;">1. An overly simplistic idealisation of the party or solution, often
ignoring obvious shortcomings or turning a blind eye to the complexities of a
debate. What is manifest here is blind love.</span></span></span></span></i></div>
<div class="MsoNormal" style="margin-left: 2cm;">
<br /></div>
<i><span style="font-family: Georgia,"Times New Roman",serif;"><span style="font-size: small;"><span style="background-color: #f3f3f3;">
</span></span></span></i><br />
<div class="MsoNormal" style="margin-left: 2cm;">
<i><span style="font-family: Georgia,"Times New Roman",serif;"><span style="font-size: small;"><span style="background-color: #f3f3f3;"><span style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 107%;">2. A corollary wish to condemn or demonise other parties or issue groups
to a degree not commensurate with the differences in their actual views. In
many cases, in fact, the closer the views of other groups to that of the
venerated group, the greater the need to castigate them. For references in
popular culture see, ‘</span><a href="http://rationalwiki.org/wiki/Zeal_of_the_convert"><span style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 107%;">The zeal of the convert’</span></a><span style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 107%;">. </span></span></span></span></i></div>
<div class="MsoNormal" style="margin-left: 2cm;">
<br /></div>
<i><span style="font-family: Georgia,"Times New Roman",serif;"><span style="font-size: small;"><span style="background-color: #f3f3f3;">
</span></span></span></i><br />
<div class="MsoNormal" style="margin-left: 2cm;">
<i><span style="font-family: Georgia,"Times New Roman",serif;"><span style="font-size: small;"><span style="background-color: #f3f3f3;"><span style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 107%;">3. Ordinary language being
replaced by slogans generated by the idealised party or issue group. Use of
these may be intensified when contrary views are put, or deeper analysis of
relevant issues is requested. Examples include, ‘Don’t blame me, I voted UKIP’
and ‘The SNP offer a fresh approach’.</span></span></span></span></i></div>
<div class="MsoNormal" style="margin-left: 2cm;">
<br /></div>
<i><span style="font-family: Georgia,"Times New Roman",serif;"><span style="font-size: small;"><span style="background-color: #f3f3f3;">
</span></span></span></i><br />
<div class="MsoNormal" style="margin-left: 2cm;">
<i><span style="font-family: Georgia,"Times New Roman",serif;"><span style="font-size: small;"><span style="background-color: #f3f3f3;"><span style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 107%;">4. Opponents may be referred to as 'career politicians', ‘elites’ or ,
‘The Establishment’. </span></span><span style="background: none repeat scroll 0% 0% rgb(246, 247, 248); line-height: 107%;">If a populist group or party makes this charge the
sufferer will instantly ignore the phalanx of pollsters, strategists and PR
people around the idealised group’s leaders and see them as ‘one of us’. </span></span></span></i><!--[if gte mso 9]><xml>
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<br /></div>
<span style="font-size: small;"><span style="font-family: Georgia,"Times New Roman",serif;"><span style="background-color: #f3f3f3;">
</span></span></span><br />
<div class="MsoNormal">
<span style="font-size: small;"><span style="font-family: Georgia,"Times New Roman",serif;"><span style="background-color: #f3f3f3;"><span style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 107%;">Do you know
someone with Populist Politics Disorder? </span><span style="background-attachment: scroll; background-clip: border-box; background-image: none; background-origin: padding-box; background-position: 0% 0%; background-repeat: repeat; background-size: auto auto; line-height: 107%;">Unfortunately
there seems to be no ready treatment available, beyond the obvious public
health measures: block these bores
on Facebook and walk away from them in cafes.
As GK Chesterton remarked, you cannot reason a man out of a position he
has not reasoned himself into. Can the Election offer a cure? We can only wait
and see.</span></span></span></span></div>
<span style="font-size: small;"><span style="font-family: Georgia,"Times New Roman",serif;"><span style="background-color: #f3f3f3;">
</span></span></span>CCCU Applied Psychologyhttp://www.blogger.com/profile/12127528347937708211noreply@blogger.com6tag:blogger.com,1999:blog-3737633890176949647.post-49271470333047223452015-02-17T09:03:00.000+00:002015-02-17T17:00:43.580+00:00Can robots help care for us as we age?<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<b><o:p> </o:p><i>Tony Prescott</i></b></div>
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<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhIep_jgLq3rmshOB67TbbhmS2Bue4b8XFMeD4gOVHWs2OMpa2pOlJcHHr3gmjc6hSaYhoCKf186hjv8ZApfQZ71Lrr-eyjaV4HhWytzEqMVSSgq5j9ZU08QEiulzxujQeI4scqL3XUzEE9/s1600/Bruce+Dern.png" imageanchor="1" style="clear: left; margin-bottom: 1em; margin-left: auto; margin-right: auto;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhIep_jgLq3rmshOB67TbbhmS2Bue4b8XFMeD4gOVHWs2OMpa2pOlJcHHr3gmjc6hSaYhoCKf186hjv8ZApfQZ71Lrr-eyjaV4HhWytzEqMVSSgq5j9ZU08QEiulzxujQeI4scqL3XUzEE9/s1600/Bruce+Dern.png" height="200" width="161" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;"><span style="font-size: xx-small;">Where'd my robot go?</span></td></tr>
</tbody></table>
<div class="MsoNormal">
In fifteen years there will 50% more over 65s than there are
today, and the proportion of older people in our society will continue to grow for
some time after that. The 2013 House of
Lords report <a href="http://www.parliament.uk/business/committees/committees-a-z/lords-select/public-services-committee/report-ready-for-ageing/"><i>Ready for Ageing? </i></a><i> </i> looked at the likely consequences of this
on-going demographic shift and stated the problem plainly: “The UK population
is ageing rapidly, but the Government and our society are woefully
underprepared”. </div>
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<o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
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On 5<sup>th </sup>March politicians from all parties will appear
at an <a href="http://www.theguardian.com/society/2015/jan/08/ageing-population-parties-policies">event</a>
in London, organised by the Guardian newspaper, to explain their policies for
addressing the ageing challenge. I hope
they offer some ambitious proposals: the status quo is not an option.</div>
<a name='more'></a><o:p></o:p><br />
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<o:p> </o:p>The <i>Ready for Ageing
Alliance</i>, a coalition of charities and think-tanks, has already produced its
<a href="http://www.independentage.org/media/816052/r4aa-maifesto-report-22-08-2014.pdf">eleven-point
manifesto for action</a>. Its focus is
primarily on what we as individuals can do to meet the coming challenge,
emphasising healthy living, active lifestyle, saving for retirement, forward
planning, being part of social networks, staying positive. </div>
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<o:p></o:p></div>
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Of course we can each play our part, but that won’t solve
the problem. Our pension, health and social care systems are already under
severe strain. How will they cope as the pressure mounts?<o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
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I’ll be looking to see how much thought the politicians have
given to how new technologies could help. I was amazed how little the House of Lords
Committee said about this. In <a href="http://www.parliament.uk/documents/lords-committees/Demographicchange/PublicServiceVol2.pdf">over
a thousand pages</a> of material there is barely a mention of the potential of new
developments such as the internet of things, smart homes, and robotics. Of
course, as the Lords report points out, new technologies are not a panacea. However,
we are a nation of inventors, designers and entrepreneurs, and in the past we
have often used these talents to help us out of tight situations. Given the current challenge, we would do well
to sharpen our vision and look where human ingenuity could take us.<o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
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My interest in this is both as an ageing UK citizen and as a
technologist. I have spent much of the
last 25 years trying to solve problems in artificial intelligence and
robotics. In 2011 I was invited to lead
a European working group on the <a href="http://www.robotcompanions.eu/system/files/page-files/Robot%20Companions%20Ethical%20Legal%20and%20Social%20Issues.pdf">potential
societal impacts of robotics</a>. We quickly decided to focus on <a href="file:///C:/Users/staff/Downloads/Prescott,%20T.%20J.%20et%20al.%20%20Robot%20Companions%20For%20Citizens:%20Roadmapping%20the%20potential%20for%20future%20robots%20in%20empowering%20older%20people.%20Conference%20on%20Bridging%20Research%20in%20Ageing%20and%20ICT%20%20Development%20(BRAID).%20Prague,%20May,%202012.%20http:/www.abrg.group.shef.ac.uk/pubs/view.php?id=266">the
possible use of robots to address the Europe-wide demographic shift</a>. Ever since then I’ve been convinced that there’s
an opportunity here that is too important to let pass. <o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
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The current telehealth technologies are mainly about
monitoring and providing healthcare advice. The underlying digital computer and
telecommunications technologies have a fundamental limitation: they can’t physically
act in the world. This is where robots are different and can make a game-changing
contribution. <o:p></o:p></div>
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In a <a href="http://www.wired.co.uk/news/archive/2015-01/20/how-robots-will-help-us-age">recent
blog piece</a> for Wired magazine I described a number of ways that assistive
robots could help us as we age: maintaining our environments by doing chores
like cleaning, and helping us with eating, toileting, and dressing. In that
piece, I make it clear that these robots are unlikely to be human-like or ‘humanoid’.
Rather, many of them will be home appliances that simply do more by themselves.
The current generation of robot vacuum cleaners exemplifies this possibility. We shouldn’t feel surprised or threatened by
this development: it continues a
long-term trend. After all, look at what happened with the first form of
automation to enter the home – the washing machine. We no longer wash clothes
by hand or squeeze out water with a mangle. Assistive robotic technologies will evolve
along similar trajectories. By 2030,
robot cleaners and helpers will be part of a larger ecology of smart devices
that will have transformed the way we perform household tasks, making our
living spaces easier to manage as we grow old.
<o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
Assistive
robots can also help at a more personal level.
Together with the designer, Sebastian Conran, and with advice
from occupational therapists and ex-patients from Sheffield Teaching Hospitals,
I am currently developing a <a href="http://gtr.rcuk.ac.uk/project/46B05215-631C-45F9-8194-F6E74A6D09EF">robotic
over-bed table</a>. If disability confines
you to bed or to a wheelchair, our table will come to you rather than you go to
it. When you are finished with the table
it will move back to a safe place and recharge.
This is a not major breakthrough in robotics - the AI required is
similar to that of the robot vacuum cleaner - but our main challenge is to make
the table completely safe and genuinely useful. We imagine that one situation where people
will use these tables is within hospital wards so they need to be able to move
around safely within the ward without bumping into people or other objects. Once they are in position over a bed they
also need to self-adjust safely, and to ensure that any objects placed on the
table top do not fall off. Each of these
challenges requires appropriate sensing and some significant artificial
intelligence.<o:p></o:p></div>
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<table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="float: right; margin-left: 1em; text-align: right;"><tbody>
<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgmObhn0_A2THusDpFt0CvxJAOk6QMF1RnWCY-kR10kVVL0ocKbrsRTavuZ0a_7fsHVlzQBjgLKa4iHSpJvOhffXKYiusrk60twUDBFU_URUWBHMpTFmm-hxlYxgZtBXPG7JHpLA9skaTmj/s1600/uses+of+robts.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgmObhn0_A2THusDpFt0CvxJAOk6QMF1RnWCY-kR10kVVL0ocKbrsRTavuZ0a_7fsHVlzQBjgLKa4iHSpJvOhffXKYiusrk60twUDBFU_URUWBHMpTFmm-hxlYxgZtBXPG7JHpLA9skaTmj/s1600/uses+of+robts.jpg" height="83" width="320" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;"><div class="MsoNormal" style="text-align: center;">
<span style="font-size: xx-small;">Possible uses for an assistive robot table.<o:p></o:p></span></div>
<div class="MsoNormal" style="text-align: center;">
<span style="font-size: xx-small;"> Images from <a href="http://www.sebastianconran.com/">Sebastian Conran Associates</a></span></div>
</td></tr>
</tbody></table>
<div class="MsoNormal">
<o:p> </o:p>At a still
more intimate level, consider personal hygiene. Smart toilets that can provide
cleaning and drying of intimate areas are already in widespread use in parts of
the world such as South Korea and Japan. In the coming decade, we can extend
the functionality of intelligent bathroom fittings so that they are more useful
to people with age-related disabilities. For many people, being helped with their
personal hygiene by a carer - potentially a complete stranger - is embarrassing
and demeaning. Assistive robots can help
us retain control over our lives and our bodies, allowing us to live
independently for longer.</div>
<div class="MsoNormal">
<o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
People also worry that using technology in this way might increase
the isolation that is <a href="http://www.ageuk.org.uk/documents/en-gb/for-professionals/evidence_review_loneliness_and_isolation.pdf?dtrk=true">already
often a problem for older people</a>.
The current generation of telehealth technologies puts some aspects of
care at a distance, and assistive robots will replace some tasks that human
carers do now. We need to take this issue
seriously and in my view we should protect access to face-to-face human support
by legislation. <o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
However, I don’t think it’s inevitable that using new
technologies to support our independence will lead to other people drawing
back. Indeed I think that the reverse
might happen. <a href="file:///C:/Cacioppo,%20J.%20T.%20and%20Patrick,%20W.%20Loneliness/%20Human%20nature%20and%20the%20need%20for%20a%20social%20connection.%20Norton%20and%20Company,%20New%20York.%202008">Research
on loneliness</a> shows that lack of control over your life can lead to
passivity and learned helplessness, feeding low self-esteem and social
withdrawal. Becoming more independent
through technology might enable us to feel better about ourselves, get out of
the house more, seek and maintain human contact, and enjoy positive
relationships that are not all built around a carer-client dynamic. <o:p></o:p></div>
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<br /></div>
<div class="MsoNormal">
There is already evidence that companion robots could help
us in our social lives. The <a href="mailto:http://www.parorobots.com">Paro
seal</a>, an animal-like robot developed in Japan, is currently being evaluated
in Sheffield for its capacity to promote social interaction in patients with dementia. <a href="http://www.theguardian.com/society/2014/jul/08/paro-robot-seal-dementia-patients-nhs-japan">Preliminary
results</a> show that Paro can increase socialisation in people who are
withdrawn by encouraging them to converse with others and by eliciting
non-verbal interactions, such as touch and stroking, with the robot.<o:p></o:p></div>
<i> </i><br />
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<o:p> </o:p><span style="text-align: center;"> </span></div>
<div class="separator" style="clear: both; text-align: center;">
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<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgtW8fCPcJuCL5z9wSEtzIsl1pwOcpNAVPj64dMJuLHHgtQfM-Sa4Q_RhYCLweHUsmNKJ951sgWEGzFibfMLH4z_1989jz8k8SZiSlxdy6LF_Ii-yhkT7v6p0XOzKdfslLlMOjOK9x9SG5d/s1600/MC+PARO.jpg" imageanchor="1" style="clear: left; margin-bottom: 1em; margin-left: auto; margin-right: auto;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgtW8fCPcJuCL5z9wSEtzIsl1pwOcpNAVPj64dMJuLHHgtQfM-Sa4Q_RhYCLweHUsmNKJ951sgWEGzFibfMLH4z_1989jz8k8SZiSlxdy6LF_Ii-yhkT7v6p0XOzKdfslLlMOjOK9x9SG5d/s1600/MC+PARO.jpg" height="150" width="200" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;"><div align="center" class="MsoNormal" style="font-size: 12.8000001907349px;">
<span style="font-size: xx-small;">Companion robots, such as the Paro </span><span style="font-size: xx-small;">seal, </span></div>
<div align="center" class="MsoNormal" style="font-size: 12.8000001907349px;">
<span style="font-size: xx-small;">encourage people to socialise </span><span style="font-size: xx-small;">and could</span></div>
<div align="center" class="MsoNormal" style="font-size: 12.8000001907349px;">
<span style="font-size: xx-small;">provide a therapeutic </span><span style="font-size: xx-small;">value </span><span style="font-size: xx-small;">similar </span></div>
<div align="center" class="MsoNormal" style="font-size: 12.8000001907349px;">
<span style="font-size: xx-small;">to that of a pet animal.</span></div>
<div align="center" class="MsoNormal" style="font-size: 12.8000001907349px;">
<span style="font-size: xx-small;">Photo: Claire Jepson.</span></div>
</td></tr>
</tbody></table>
<div class="MsoNormal" style="text-align: left;">
Some are
concerned about how assistive robots might impact on the caring
professions. However, good professional
carers are already scarce and are becoming scarcer. The UK has a shortage of nurses
and residential care workers, and this will only worsen as the <a href="file:///C:/The%20King%C3%A2%C2%80%E2%84%A2s%20Fund%20%20(Candace%20Imison,%20Richard%20Bohmer).%20NHS%20and%20social%20care%20workforce/%20meeting%20our%20needs%20now%20and%20in%20the%20future%3f,%2025th%20July%202013">number
of care jobs increases by up to one million by 2025</a>. Robots can help compensate for this skills
shortage by assisting professional carers in their work, and by reducing
work-related injuries, such as chronic back-strain, that otherwise lead some
experienced carers to retire early. Working
with teams of assistive robots, the role of a professional carer will become
more skilled and respected, less physical, less routine, and more focused on
the people being cared for. Wages and
working conditions for care workers are often scandalously poor: introducing
more technology into care work could raise its status.</div>
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<o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
Across
Europe, we are moving from a situation where we have three working people for
every one potential dependent (someone either over sixty-five or below
eighteen) to one where, by 2060, that <a href="file:///C:/Eurostat%20demography%20report%202010.%20http/::epp.eurostat.ec.europa.eu:">ratio
could be one-to-one</a>. The world in 2060 will be very different, and
it is not unrealistic to imagine that assistive technologies will be very
advanced by that time. This is good to
know, because otherwise families will be faced with what looks like an
impossibly high burden. <o:p></o:p></div>
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<br /></div>
<div class="MsoNormal">
The House of Lords is right to think that technology can’t
fix all of the issues arising from this demographic shift. However, I believe that it can and should be a
part of the solution, and robotic technologies will have an important role to
play. The problems arising from our ageing
population won’t happen overnight, but as we look around and see more of our
older citizens miserable and neglected, we need to think about what actions we can
take and to start rethinking how our society cares for older people. As part of the mix, I believe we would be
doing a disservice to both ourselves and our children, to ignore the
opportunity provided by assistive robots. <o:p></o:p></div>
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<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<a href="http://www.shef.ac.uk/psychology/staff/academic/tony-prescott"><b><i>Tony
Prescott</i></b></a><b><i> </i></b><i>is a Professor of
Cognitive Neuroscience at the University of Sheffield, a Fellow of the British
Psychological Society, and the Director of Sheffield Robotics (</i><a href="http://www.sheffieldrobotics.ac.uk/"><i>http://www.sheffieldrobotics.ac.uk</i></a><i>) a cross-institutional robotics facility
with over one hundred active researchers.
He regularly speaks and writes about the potential societal impacts and
risks of advanced technologies such as AI and robotics. You can follow him on
Twitter </i><a href="https://twitter.com/tonyjprescott"><i>@tonyjprescott</i></a><i>.</i></div>
CCCU Applied Psychologyhttp://www.blogger.com/profile/12127528347937708211noreply@blogger.com6tag:blogger.com,1999:blog-3737633890176949647.post-50247250692621118312015-02-10T13:51:00.001+00:002015-02-10T18:36:17.986+00:00Mad, bad or maybe merely human<div class="MsoNormal">
</div>
<div class="MsoNormal">
<b><i><span lang="EN-US"><a href="http://discursiveoftunbridgewells.blogspot.co.uk/search/label/Peter%20Kinderman%20%28Author%29">Peter Kinderman</a><o:p></o:p></span></i></b></div>
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<table cellpadding="0" cellspacing="0" class="tr-caption-container" style="float: left; margin-right: 1em; text-align: left;"><tbody>
<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiOhiJHXSxQIFVZuJojJRiMTCey-HdTSCGF2gO3PZiUSnykdsXm49YotaZeC-lwNN6hCYgifpRuDJMyCIhVsoLTgx8W7Ca3oc6RxjrnclUjO-wQnrdSGi6gv0z9BGWogJedI3fuDm9oaej8/s1600/Prison.jpg" imageanchor="1" style="clear: left; margin-bottom: 1em; margin-left: auto; margin-right: auto;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiOhiJHXSxQIFVZuJojJRiMTCey-HdTSCGF2gO3PZiUSnykdsXm49YotaZeC-lwNN6hCYgifpRuDJMyCIhVsoLTgx8W7Ca3oc6RxjrnclUjO-wQnrdSGi6gv0z9BGWogJedI3fuDm9oaej8/s1600/Prison.jpg" height="133" width="200" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;"><span style="font-size: xx-small;">Is a mental health diagnosis <br />necessary to avoid prison?<br />Photo: <a href="https://www.flickr.com/people/59222181@N03">Liam Quinn</a></span></td></tr>
</tbody></table>
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<span lang="EN-US">The British Psychological Society’s report ‘<a href="http://www.understandingpsychosis.net/">Understanding Psychosis and
Schizophrenia</a>’ has challenged many commonly held beliefs about serious
mental health problems. While the report has been <a href="http://www.theguardian.com/society/2014/dec/02/psychosis-rational-talk-therapy">widely
welcomed</a>, it has also prompted questions, particularly focusing on the
report’s key recommendation that we move beyond seeing distress as a symptom of
disease:<o:p></o:p></span></div>
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<div class="MsoNormal" style="margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 1.0cm; margin-right: 25.15pt; margin-top: 0cm;">
<i><span lang="EN-US"><br /></span></i></div>
<div class="MsoNormal" style="margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 1.0cm; margin-right: 25.15pt; margin-top: 0cm;">
<i><span lang="EN-US"><br /></span></i></div>
<div class="MsoNormal" style="margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 1.0cm; margin-right: 25.15pt; margin-top: 0cm;">
<i><span lang="EN-US">‘services should not insist that people accept any one
framework of understanding, for example the idea that their problems are
symptoms of an underlying illness’. <o:p></o:p></span></i></div>
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<span lang="EN-US">This issue has been addressed on this site
on a <a href="http://discursiveoftunbridgewells.blogspot.co.uk/search/label/Psychiatric%20Diagnosis">number
of occasions</a> and it’s clearly one that arouses strong feelings. The
disease-model of modern psychiatry views emotional distress as the result of
illnesses or disorders. Treating such problems in this way, as healthcare issues,
is often <a href="http://www.huffingtonpost.com/allen-frances/pro-and-con-the-british-psychological-society-report-on-psychosis_b_6315878.html">seen
as essential</a> for ensuring that people get the help they need, and vital in avoiding
inappropriate treatment. In particular, some
colleagues have <a href="http://www.huffingtonpost.com/allen-frances/pro-and-con-the-british-psychological-society-report-on-psychosis_b_6315878.html">suggested</a>
that viewing people as ‘mentally ill’ prevents them being blamed for actions
for which they are not responsible. Rather than being seen as bad you can be
mad (or more accurately sick) and more likely to be treated rather than simply
punished. Removing this protection (the
argument continues) may even result in people being sent to prison
inappropriately. These are clearly serious concerns and deserve careful
consideration.</span></div>
<a name='more'></a><o:p></o:p><br />
<div class="MsoNormal">
<span lang="EN-US"> </span><i><span lang="EN-US">The
services you need - Care</span></i></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span lang="EN-US">No matter how often it’s advanced, the idea
that a diagnosis ensures that people get the services they need, fails at the
first hurdle. Despite the <a href="http://www.bbc.co.uk/news/health-20986796">epidemic</a>
of <a href="http://ebmh.bmj.com/content/early/2012/09/20/eb-2012-100987">psychiatric
diagnosis</a>, people with mental health problems are clearly already failing
to get the help they need. In the UK, even the Government Minister responsible has
suggested that mental health services are ‘<a href="http://www.bbc.co.uk/news/health-28851443">stuck in the dark ages</a>’. The
quasi-independent <a href="http://www.rethink.org/media/514093/TSC_main_report_14_nov.pdf">Schizophrenia
Commission</a> has stated that ‘the message that comes through loud and clear
is that people are being badly let down by the system in every area of their
lives’. In other words, the current
system is failing, and something different is needed. <o:p></o:p></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span lang="EN-US">So how do we ensure that people with
obvious and quantifiable needs (themselves intimately associated with their <a href="http://www.bmj.com/content/345/bmj.e5142">social circumstances</a><span class="MsoHyperlink">)</span> get the help they need without the use of
diagnosis? The answer is in the question – we need to address <a href="http://blogs.scientificamerican.com/mind-guest-blog/2014/11/17/why-we-need-to-abandon-the-disease-model-of-mental-health-care/">identified
problems</a><span class="MsoHyperlink"> rather than hypothetical ‘illnesses’</span>.
It isn’t complicated: we can operationally define, measure, research,
understand and offer help for the specific problems that people identify.
Perhaps even more importantly we can also broaden our focus, from individuals
to the social challenges that give rise to these problems. We can offer
practical help, negotiate social benefits (which could be financial support,
negotiated time off work, or deferred studies, for example), or offer
psychological or emotional support. There no need to maintain that people are ‘ill’:
attention to people’s real problems will offer the most straightforward route
to getting them the services they need.<o:p></o:p></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<i><span lang="EN-US">The
services you don’t need – Prison<o:p></o:p></span></i></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span lang="EN-US">So what about the charge that failing to
identify distress as illness may result in inappropriate blame and even jail?<o:p></o:p></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span lang="EN-US">The relationship between mental health and
criminal justice, particularly imprisonment, is indeed something that we
urgently need to think about. The majority of people with mental health
problems are neither criminal nor violent, although there is a <a href="http://archpsyc.jamanetwork.com/article.aspx?articleid=210191">complex
relationship</a> between substance use, mental health and criminal offending.
Perhaps because of that complex interaction, it’s also been estimated that up
to <a href="http://www.theguardian.com/society/joepublic/2009/jul/02/prisons-mental-health-illness">90%
of the UK’s prison population</a> has some form of mental health problem (with
comparable figures in the <a href="http://nicic.gov/mentalillness">US</a>). This
suggests that the dominant medical model has not kept people with mental health
problems (who do not tend to be violent) out of jail. <o:p></o:p></span></div>
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<div class="MsoNormal">
<span lang="EN-US">Having said that, it is important to
understand how mental health issues relate to criminality. Clearly the relationship
is complex: it simply doesn't follow that, if you commit a crime and also meet
the criteria for a recognized mental disorder, then you can’t be found guilty
or sent to jail. To take one simple example; a very large number of people are
in prison for drugs offences, and their difficulties with substance use have
been recognized and discussed in their trials, often cited as motives for
acquisitive crimes. Once sentenced, people are (sometimes) offered
interventions to address their substance use. But a diagnosis of ‘substance use
disorder’ (a psychiatric condition listed in the diagnostic manuals) simply does
not result in people avoiding prison. In truth, holding people responsible for
their behaviour is a necessary cornerstone of civil society. Equally, our
criminal justice system must take appropriate account of people’s personal and
social circumstances. I’m not saying we should ignore people’s very real mental
health problems and their possible relationship with offending. But I am saying
that a diagnostic ‘disease model’ does not, in practice, help very much. Instead,
we need to understand a little more about the functional relationship between
mental health and personal responsibility. <o:p></o:p></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<i><span lang="EN-US">Who
(or what) is to blame?<o:p></o:p></span></i></div>
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<br /></div>
<div class="MsoNormal">
<span lang="EN-US">Issues of free will and personal
responsibility have been the subject matter of philosophy for over 4,000 years,
and currently exercise jurisprudence, criminology, sociology, neuroscience, and
politics as well as psychology and psychiatry. Simple solutions are unlikely.
It is clear, however, that the invocation of a ‘mental illness’ is a
non-solution to the problem. The traditional argument seems to be that, if
somebody with a diagnosed mental health problem commits a crime, then the
illness ‘made them do it’. This argument seems superficially to address various
issues: if we blame the illness, we don’t have to respond punitively to a
person in crisis, and if we cure the illness, we solve the problem. Then the
individual can be offered medical care rather then a criminal justice solution.
<o:p></o:p></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span lang="EN-US">But this is a simplistic and often
unhelpful response. The notion of mental illnesses as entities separable from
our social and cultural normative values is a <a href="http://ebmh.bmj.com/content/early/2012/09/20/eb-2012-100987">myth</a><span class="MsoHyperlink">.</span> It is a circular argument to identify some aspects
of our psychological functioning as ‘illnesses’ and then accord special legal
status to them. Moreover this argument is applied inconsistently. The fact that
a large proportion (perhaps the majority) of people in the criminal justice
system have identifiable mental health problems suggests that, in most cases,
these ‘illnesses’ have not, in fact, accorded them special status. At the same
time, it’s equally clear that the vast majority of people whose problems do
meet the diagnostic criteria for identified mental ‘disorders’ are perfectly
able to take responsibility for their decisions, even those related to possible
criminal activity.<o:p></o:p></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span lang="EN-US">But if the notion of ‘mental illness’
fails, in truth, properly to address the challenges of the relationship between
psychological problems and criminality, what’s the alternative? How should we think about these issues? How can
we ensure that people get the help they need and that they don’t get sent to
prison when it’s not appropriate? <o:p></o:p></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span lang="EN-US">As in any other situation, people should
receive the help they need for their identifiable problems. There’s no need to
invoke the notion of ‘illness’ to achieve this – we don’t invoke this concept
in other areas of civic society: housing, education, financial help, etc. And
we don’t need the notion of illness in order to protect people from
inappropriate legal sanctions. In criminal proceedings, we should have the
maturity as civilized societies to take all of the relevant psychosocial
aspects into account when choosing sentencing options. There is no need to
invoke ‘illnesses’ for Courts to understand, and take account of, the psychological
and social issues that influenced a person’s behaviour and their state of mind
at the time of an offence. <o:p></o:p></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span lang="EN-US">What would be wrong with a model of psychological
well-being which accepts that biological, social, and circumstantial factors impact
on our actions? In other words, extreme circumstances can affect our judgement.
When Courts take account of these issues - for instance, when sentencing
someone for a crime - people are presumed to have personal responsibility
unless it can be demonstrated otherwise, but the criminal justice system can be
flexible. We should set clear and robust criteria for such decisions, and we
should use established rules for both legal and scientific evidence. We need
scientific expertise to guide the criminal justice system through the <a href="http://archpsyc.jamanetwork.com/article.aspx?articleid=210191">complex
relationships</a> described earlier. But we don’t require the notion of illness.
<o:p></o:p></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<i><span lang="EN-US">So…<o:p></o:p></span></i></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span lang="EN-US">So how can we ensure that people with
obvious and quantifiable needs get the help they need, including for the social
problems that often gave rise to the difficulties in the first place, and avoid
inappropriate entanglement in the criminal justice system? For those of us
promoting a <a href="http://www.palgrave.com/page/detail/a-prescription-for-psychiatry-peter-kinderman/?K=9781137408709">psychosocial
approach</a>, the answer is clear. We need to identify each person’s specific
needs and offer them appropriate services. We need to identify the social
challenges that give rise to these problems, and work to address them. By
appreciating how such factors have impacted on person’s psychological
well-being, we would also be able to determine the extent to which their
ability to make rational, responsible, decisions have been compromised. Such a
determination should be part of any Court’s adjudication, So do we really need the idea of illness?<o:p></o:p></span></div>
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CCCU Applied Psychologyhttp://www.blogger.com/profile/12127528347937708211noreply@blogger.com16tag:blogger.com,1999:blog-3737633890176949647.post-28728656618138095732015-02-03T13:17:00.004+00:002015-02-04T08:25:27.266+00:00The allure of the new<!--[if gte mso 9]><xml>
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<br />
<div class="MsoBodyText">
<span style="font-size: small;"><span style="font-family: Georgia,"Times New Roman",serif;"><i>Charlie Tyack</i></span></span></div>
<div class="MsoBodyText">
<br /></div>
<div style="text-align: left;">
</div>
<div style="text-align: left;">
</div>
<table cellpadding="0" cellspacing="0" class="tr-caption-container" style="float: left; margin-right: 1em; text-align: left;"><tbody>
<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEioK3oHQtb1Mj6xj812s6I6YVNX8Y4lccPs-edO3HdtaYLVOo1GT0Hz4CQ06HgC5xpa94hgshHrl3hiFYyREi3pmQfnXIFqpPXsQgEyepHTEbpAXeelmQ7M2CKKQtIRomHqyDa6nedtVJU_/s1600/Neuronal_activity_DARPA.jpg" imageanchor="1" style="clear: left; margin-bottom: 1em; margin-left: auto; margin-right: auto;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEioK3oHQtb1Mj6xj812s6I6YVNX8Y4lccPs-edO3HdtaYLVOo1GT0Hz4CQ06HgC5xpa94hgshHrl3hiFYyREi3pmQfnXIFqpPXsQgEyepHTEbpAXeelmQ7M2CKKQtIRomHqyDa6nedtVJU_/s1600/Neuronal_activity_DARPA.jpg" height="155" width="200" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;"><div style="font-size: 12.8000001907349px;">
<span style="font-size: xx-small;">Going deep. But are we getting</span></div>
<div style="font-size: 12.8000001907349px;">
<span style="font-size: xx-small;">to the roots of distress?</span></div>
<div style="font-size: 12.8000001907349px;">
<span style="font-size: xx-small;">Photo: <a href="http://www.darpa.mil/NewsEvents/Releases/2014/05/27a.aspx">DARPA</a></span></div>
</td></tr>
</tbody></table>
<span style="font-size: small;"><span style="font-family: Georgia,"Times New Roman",serif;">As human beings, we are
attuned to notice the special or different. We also tend to like simple answers
to complex questions. Perhaps they make us feel more in control of the complicated
environments we find ourselves in. I wondered about this during a recent trawl
for ‘depression cures’ on news websites. Suggestions included <a href="http://www.google.co.uk/url?sa=t&rct=j&q=&esrc=s&source=newssearch&cd=1&ved=0CCAQqQIoADAA&url=http%3A%2F%2Fwww.mirror.co.uk%2Fnews%2Freal-life-stories%2Flosing-9-stone-helped-cure-4915041&ei=ytqrVIrzKIb0UsTngugK&usg=AFQjCNGJ8DHS2eZ7U90S7sZmLujUUVBdoA&bvm=b">9-stone
weight loss</a>, <a href="http://www.vox.com/2014/12/22/7424477/mushrooms-research">magic mushrooms</a>
(complete with obligatory 3D brain picture to enhance credibility), <a href="http://www.latimes.com/science/sciencenow/la-sci-sn-laughing-gas-depression-20141209-story.html">laughing
gas</a> and <a href="http://www.youthhealthmag.com/articles/4902/20141214/ketamine-depression-mental-health.htm">ketamine</a>.
It seems that we are on the lookout for simple-sounding and miraculous cures
for our ailments. After all, the prospect that things can be fixed ever faster
and with less effort sounds great. With a bias towards the novel and apparently
miraculous, I wonder how we can appraise new, glamorous or cutting edge treatments?
Can we judge such shiny new arrivals fairly?</span></span><br />
<a name='more'></a><br />
<br />
<span style="font-size: small;"><span style="font-family: Georgia,"Times New Roman",serif;">A recent example of such a
new treatment is <a href="http://www.medtronicdbs.com/">Deep Brain Stimulation</a> (DBS)
DBS seems to be helpful to people experiencing a range of
motor-related physical problems, and is most commonly used with people
experiencing Parkinson’s disease. Implantation of electronic devices to help
people to overcome physical conditions seems to make sense, and <a href="http://onlinelibrary.wiley.com/doi/10.1002/mds.23796/abstract">qualitative
explorations of the impact of DBS for people with primary dystonia </a>(a
condition characterised by involuntary muscle spasms) suggest its effects can
be life-transforming. </span></span><br />
<span style="font-size: small;"><span style="font-family: Georgia,"Times New Roman",serif;"><br /></span></span>
<span style="font-size: small;"><span style="font-family: Georgia,"Times New Roman",serif;">But, there is a danger here
that may come from the magnetic attraction of the shiny and new. In particular I
was somewhat concerned to learn of possible <a href="http://dictionary.cambridge.org/dictionary/business-english/mission-creep">mission
creep </a>for DBS. If it’s good for the difficulties above might it also help
with other problems? DBS is currently being piloted for use with people
experiencing emotional distress. This results from mood-related side-effects
that were reported by people being treated for physical conditions with DBS. People
diagnosed with depression and people diagnosed with <a href="http://www.medtronic.com/patients/obsessive-compulsive-disorder-ocd/about-therapy/our-dbs-therapy-products/index.htm">Obsessive
Compulsive Disorder (OCD)</a> have been part of pilot trials to see whether DBS
can help them. Some of the language used in the reporting of these trials seems,
at the very least, detached from the human experience of depression:</span></span><br />
<br />
<div style="margin-left: 36pt;">
<span style="font-size: small;"><span style="font-family: Georgia,"Times New Roman",serif;"><i>‘DBS
to different sites allows interfering with dysfunctional network function
implicated in major depression’. (</i><a href="http://www.nature.com/npp/journal/v33/n2/full/1301408a.html"><i>Link</i></a><i>).</i></span></span></div>
<div style="margin-left: 36pt;">
<br /></div>
<span style="font-size: small;"><span style="font-family: Georgia,"Times New Roman",serif;">And, in relation to OCD:</span></span><br />
<br />
<div style="margin-left: 36pt;">
<span style="font-size: small;"><span style="font-family: Georgia,"Times New Roman",serif;"><i>‘OCD
is essentially the result of faulty wiring in the brain’. (</i><a href="http://www.webmd.com/mental-health/news/20130224/scientists-pinpoint-how-deep-brain-stimulation-eases-ocd"><i>Link</i></a><i>)</i></span></span></div>
<div style="margin-left: 36pt;">
<br /></div>
<span style="font-size: small;"><span style="font-family: Georgia,"Times New Roman",serif;">Such explanations for an
effect of DBS seem to locate the problems people are experiencing very
much within them, implying that their difficulties are due only to faulty
connections, rather than being related to ways that they are trying to
navigate difficulties that they are experiencing or have experienced in the
past. Viewing a treatment in this way takes agency away from the person, and
might make changes they experience seem artificial, or divorced from their
realities. If they feel better when their stimulator battery is topped up, or
settings are modified, then is that something they can feel ownership of? Do
they decide their settings, or does a professional set them, potentially
implying expert-knowledge of what might be the best emotional state for
them? </span></span><br />
<br />
<span style="font-size: small;"><span style="font-family: Georgia,"Times New Roman",serif;">Who decides what the
correct state of mind someone should experience is? What if people felt better
when nothing had apparently been changed in relation to the DBS implants: is it
a result of their efforts, related to the DBS, or to something else? Given
control over one’s own implants, might it become possible to become
somewhat lost, chasing some idealised emotional state, unsure if what one was
feeling in the present was genuine? There is an overlap here with possible
interpretations people might make with medications. However, people have
more control over their medications: they can often choose to stop taking them,
and if they do, there is no hardware to surgically remove.</span></span><br />
<br />
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<br />
<span style="font-size: small;"><span style="font-family: Georgia,"Times New Roman",serif;">According to the <a href="http://www.nimh.nih.gov/health/topics/brain-stimulation-therapies/brain-stimulation-therapies.shtml">National
Institute of Mental Health</a> DBS carries risks associated with any type of
brain surgery. For example, the procedure may lead a number of unwanted effects including: b</span></span><span style="font-family: Georgia, 'Times New Roman', serif; text-indent: -17.85pt;">leeding
in the brain or stroke, i</span><span style="font-family: Georgia, 'Times New Roman', serif; text-indent: -17.85pt;">nfection, d</span><span style="font-family: Georgia, 'Times New Roman', serif; text-indent: -17.85pt;">isorientation
or confusion, </span><span style="font-family: Georgia, 'Times New Roman', serif; text-indent: -17.85pt;">mood changes, m</span><span style="font-family: Georgia, 'Times New Roman', serif; text-indent: -17.85pt;">ovement
disorders, </span><span style="font-family: Georgia, 'Times New Roman', serif; text-indent: -17.85pt;"><span style="font-feature-settings: normal; font-kerning: auto; font-language-override: normal; font-size-adjust: none; font-stretch: normal; font-style: normal; font-synthesis: weight style; font-variant: normal; font-weight: normal; line-height: normal;"> l</span></span><span style="font-family: Georgia, 'Times New Roman', serif; text-indent: -17.85pt;">ight-headedness and</span><span style="font-family: Georgia, 'Times New Roman', serif; text-indent: -17.85pt;"><span style="font-feature-settings: normal; font-kerning: auto; font-language-override: normal; font-size-adjust: none; font-stretch: normal; font-style: normal; font-synthesis: weight style; font-variant: normal; font-weight: normal; line-height: normal;"> t</span></span><span style="font-family: Georgia, 'Times New Roman', serif; text-indent: -17.85pt;">rouble
sleeping.</span><br />
<div style="margin-left: 71.7pt; text-indent: -17.85pt;">
<br /></div>
<span style="font-size: small;"><span style="font-family: Georgia,"Times New Roman",serif;">Because the procedure is
still experimental, other side effects that are not yet identified may be
possible. Long-term benefits and side effects are unknown. Perhaps it’s
therefore unsurprising that, regarding DBS, <a href="http://www.ocduk.org/deep-brain-stimulation">OCD-UK states</a>:</span></span><br />
<br />
<div style="margin-left: 36pt;">
<span style="font-size: small;"><span style="font-family: Georgia,"Times New Roman",serif;"><i>‘OCD-UK
do not recommend DBS as a treatment for OCD and remain concerned that the
dangers associated with the procedure continue to be overlooked by the medical
community when much safer and less invasive treatments remain available.’</i></span></span></div>
<div style="margin-left: 36pt;">
<br /></div>
<span style="font-size: small;"><span style="font-family: Georgia,"Times New Roman",serif;">If DBS for distress is
found to be <i><span style="font-style: normal;">effective</span></i><i>, </i><i><span style="font-style: normal;">and safety concerns can be addressed</span></i><i>,</i> who will decide
who receives surgery? Will people experiencing the conditions decide? Will the
state decide? Are we at risk of re-treading the path forged by <a href="http://www.britannica.com/blogs/2011/09/walter-freeman-ii-lobotomy-probing-answers/">Walter
Freeman II</a>, inventor and prolific practitioner of the ‘ice pick’
lobotomy, who seemed to genuinely believe that his intervention was a panacea
for mental health issues? <i>He </i>seemed
pretty confident<i> </i>about the emotional
state people should be in. There may also be there parallels with the continued
administration of electroconvulsive therapy, <a href="http://www.ncbi.nlm.nih.gov/pubmed/21322506">whose evidence is tenuous at
best</a>. I also wonder if, as well as novelty, we also value treatments which
are dramatic. Part of a primal urge to
physically destroy the source of our suffering, as suggested by <a href="http://www.ancient-wisdom.co.uk/surgery.htm#treppaning">prehistoric
remains found with injuries indicative of trepannings</a>?</span></span><br />
<br />
<span style="font-size: small;"><span style="font-family: Georgia,"Times New Roman",serif;">So when we are presented
with miraculous-sounding cures, perhaps we need to exercise healthy scepticism
and, whilst not automatically dismissing them, ask some relatively
straightforward questions:</span></span><br />
<ul>
<li><span style="font-size: small;"><span style="font-family: Georgia,"Times New Roman",serif;"><span style="font-feature-settings: normal; font-kerning: auto; font-language-override: normal; font-size-adjust: none; font-stretch: normal; font-style: normal; font-synthesis: weight style; font-variant: normal; font-weight: normal; line-height: normal;"></span>On
which evidence shall our decisions be based? </span></span></li>
<li>
<span style="font-size: small;"><span style="font-family: Georgia,"Times New Roman",serif;"><span style="font-feature-settings: normal; font-kerning: auto; font-language-override: normal; font-size-adjust: none; font-stretch: normal; font-style: normal; font-synthesis: weight style; font-variant: normal; font-weight: normal; line-height: normal;"></span>In
whose interests was that evidence collected and presented?</span></span></li>
<li>
<span style="font-size: small;"><span style="font-family: Georgia,"Times New Roman",serif;"><span style="font-feature-settings: normal; font-kerning: auto; font-language-override: normal; font-size-adjust: none; font-stretch: normal; font-style: normal; font-synthesis: weight style; font-variant: normal; font-weight: normal; line-height: normal;"></span>Who
stands to benefit from the treatment? This extends beyond potential recipients
to the companies producing them, and the reputations of the people associated
with them.</span></span></li>
<li>
<span style="font-size: small;"><span style="font-family: Georgia,"Times New Roman",serif;"><span style="font-feature-settings: normal; font-kerning: auto; font-language-override: normal; font-size-adjust: none; font-stretch: normal; font-style: normal; font-synthesis: weight style; font-variant: normal; font-weight: normal; line-height: normal;"></span>And
last but <i>never </i>least<i>, </i>do the potential benefits outweigh the
risks?</span></span></li>
</ul>
CCCU Applied Psychologyhttp://www.blogger.com/profile/12127528347937708211noreply@blogger.com2tag:blogger.com,1999:blog-3737633890176949647.post-67973309594389307222015-01-23T16:47:00.003+00:002015-01-23T17:07:41.474+00:00We have the right to offend, but when should we? <div class="MsoNoSpacing" style="border: none; mso-padding-alt: 0cm 0cm 0cm 0cm;">
<i><span lang="EN-US"><span style="font-family: Georgia, Times New Roman, serif;">Following
the Charlie Hebdo attacks <a href="http://discursiveoftunbridgewells.blogspot.co.uk/search/label/Angela%20Gilchrist%20%28Author%29">Angela Gilchrist</a> looks at how we
think about those we see as ‘different’.<o:p></o:p></span></span></i></div>
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<br /></div>
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<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEi37nXhxIY971cpQJdsr9RUPpL5sqSOSgmrTTCvk8aiUuSc60zo3k6LyxB8y6wrhDso-jA7u1KQWbnro0nuxTg8NH7-di9tvj7NkEY410Wrv7-G-ZGhotxbi5zQ1RTDaWiX3gC-RLZsct7p/s1600/Charlie+Hebdo.jpg" imageanchor="1" style="clear: left; margin-bottom: 1em; margin-left: auto; margin-right: auto;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEi37nXhxIY971cpQJdsr9RUPpL5sqSOSgmrTTCvk8aiUuSc60zo3k6LyxB8y6wrhDso-jA7u1KQWbnro0nuxTg8NH7-di9tvj7NkEY410Wrv7-G-ZGhotxbi5zQ1RTDaWiX3gC-RLZsct7p/s1600/Charlie+Hebdo.jpg" height="100" width="200" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;"><span style="font-size: xx-small;">We can protest for our freedom but can we<br />also accept difference?<br />Photo: Claude Truong Ngoc </span></td></tr>
</tbody></table>
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<span lang="EN-US"><span style="font-family: Georgia, Times New Roman, serif;">The right to freedom of
speech reached a watershed with the <span style="color: #0070c0;"><a href="http://www.independent.co.uk/news/world/europe/world-leaders-gather-for-freedom-march-in-paris-as-million-expected-at-rally-9970512.html">Je Suis Charlie</a></span> march in
Paris. Not only did it reveal <a href="http://www.slate.com/blogs/the_world_/2015/01/14/dieudonn_last_week_french_officials_stood_up_for_offensive_speech_this_week.html"><span style="color: blue;">double standards</span></a> but it highlighted
how easily liberty is talked about, yet how impossibly difficult to realise.<o:p></o:p></span></span></div>
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<span lang="EN-US"><span style="font-family: Georgia, Times New Roman, serif;">The sentiments were
admirable, even moving. But as world leaders who have journalists locked up in
their own countries marched under the Je Suis Charlie banner along with well-known
Western leaders, some began to worry about the trickier, more complex aspects
to this debate.<o:p></o:p></span></span></div>
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<span lang="EN-US"><span style="font-family: Georgia, Times New Roman, serif;">Does the <i>legal</i> <i>right</i>
to offend others, make it <i>desirable</i>, and if so, when? If you’re a person
who belongs to a marginalised, often discriminated against group, such as those with disabilities, LGBT people
or those who happen to be religious, you’ll know how it feels to have your
particular ‘issue’ lampooned. It’s painful, and we become defensive. What many
fail to understand though, is how this all too human foible remains (as indeed
it must) separate to the right of free speech.</span></span></div>
<span lang="EN-US"><span style="font-family: Georgia, Times New Roman, serif;"></span></span><br />
<a name='more'></a><br />
<span lang="EN-US"><span style="font-family: Georgia, Times New Roman, serif;"><o:p></o:p></span></span><br />
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<span style="font-family: Georgia, Times New Roman, serif;"><span lang="EN-US"> </span>The ability to laugh at
ourselves and our fellow humans can provide relief in an otherwise serious
world, or give rise to unexpressed, yet critical insights. Even more
importantly, a free flow of communication, satirical or otherwise; allows the
public to remain informed. For these
reasons and others, we cannot legalise against the notion of offence. But
healthy as it might be, freedom of speech in a diverse and multicultural
society is far from straightforward.</span></div>
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<span style="font-family: Georgia, Times New Roman, serif;"><span lang="NL">A
psychological explanation as to why we sometimes relish offending others but
find it harder to accept for ourselves, is found in Tajfel </span><span lang="FR">and Turner’s</span><span lang="FR"> </span><span lang="EN-US" style="color: #0070c0;"><a href="http://www.utwente.nl/cw/theorieenoverzicht/Theory%20Clusters/Interpersonal%20Communication%20and%20Relations/Social_Identity_Theory/">social identity theory</a></span><span lang="EN-US">. Tajfel and Turner argued
that we find our identity in groups and that we all have a tendency to believe
our own group is superior to others. In this way, we create ‘out’ groups or
make people who are different to ourselves, ‘other’. Some cultural
psychologists believe this was originally protective. Primitive humans needed to
identify hostile tribes and have a means of <span style="color: #0070c0;"><a href="http://www.zeepedia.com/read.php?major_theories_in_cultural_anthropology_diffusionism_cultural_anthropology&b=98&c=3">protecting interests</a></span> as
they competed for resources down the centuries.<o:p></o:p></span></span></div>
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<span lang="EN-US"><span style="font-family: Georgia, Times New Roman, serif;">The real challenge of
freedom of speech is giving the same rights to out groups as to in groups. For
example, asylum seekers are arguably an out group in our society at present,
but if they became British citizens and won seats in Parliament, they would
become an in group and perhaps be less easy to lampoon.<o:p></o:p></span></span></div>
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<span lang="EN-US"><span style="font-family: Georgia, Times New Roman, serif;">And whether we’re talking
about in or out groups, freedom of speech can never be absolute. Our need for
expression is curtailed by laws on hate speech, security legislation, concerns
about fraudulent advertising and restrictions on defamation and slander. Most
free speech pundits would agree that this is desirable. But how do we decide
when mere offence becomes hate speech? At what point is parody and satire
defamatory or slanderous? Some argue
that the Charlie Hebdo cartoons are <span style="color: #0070c0;"><a href="http://www.theglobeandmail.com/globe-debate/are-frances-shocking-cartoons-hurtful-or-beneficial-to-minorities/article22549015/">racist</a></span> and marginalise
immigrant communities and Muslims in particular. Others say the cartoons address <span style="color: #0070c0;"><a href="http://www.theatlantic.com/international/archive/2015/01/charlie-hebdo-and-the-right-to-be-offended/384404/">pertinent, perhaps even vital, issues</a></span>
that deserve of our attention. <o:p></o:p></span></span></div>
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<span lang="EN-US"><span style="font-family: Georgia, Times New Roman, serif;">As free as our speech might
be in the West, there are - and always have been - areas of taboo. These shift
over time as social norms change alongside the tides of history. <o:p></o:p></span></span></div>
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<span lang="EN-US"><span style="font-family: Georgia, Times New Roman, serif;">Some have suggested that in
this post-Holocaust era few would want to parody Jews, while Muslims seem fair
game in the eyes of some. And the double-standard has not escaped the attention
of moderate Muslims in favour of free speech, but also <span style="color: #0070c0;"><a href="http://www.huffingtonpost.co.uk/mehdi-hasan/charlie-hebdo-free-speech_b_6462584.html">desirous of respect</a></span>.
Arguably then, freedom of speech is in part, socially constructed.<o:p></o:p></span></span></div>
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<span lang="EN-US"><span style="font-family: Georgia, Times New Roman, serif;">Here we reach the nub of
things: while freedom of expression and the right to offend must remain
inviolate in a democratic society, how can we decide when it is desirable? Such
decisions should not be taken lightly, and should never be gratuitous. Perhaps it
is only reasonable and ethical to risk offending a sector of the public if it
informs opinion or highlights an issue to make a necessary point. This is not
self-censorship, it is respect and tolerance for the sensibilities of those
with whom we share our society. It is the responsibility that comes with
freedom.<o:p></o:p></span></span></div>
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<span lang="EN-US"><span style="font-family: Georgia, Times New Roman, serif;">This discretion is the
hallmark of a seasoned editor, in much the same way as good clinical judgment
is (or should be) the preserve of an experienced clinician. The wise writer or
film director will not ridicule others or use violence
gratuitously, but only where it informs the plot and characters or tells us something crucial
about an issue. What is appropriate in one situation may be
ill-advised in another. We always need to balance the right to free expression
and the public’s ‘right to know’, against the possible fall-out that will occur
when a group is offended for no good reason. Arguably, those who hold the least
power in our society are seen to have the least access to freedom of speech,
although this is implicit and rarely articulated. <o:p></o:p></span></span></div>
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<span lang="EN-US"><span style="font-family: Georgia, Times New Roman, serif;">If we’re honest with
ourselves, no matter how libertarian we might be, we will feel the desire to
silence others on occasions, even when we know this is wrong. It can be hard to
accord the right of free speech to those with whom we profoundly disagree. My
mind goes back a few years to a broadcast of BBC’s ‘Question Time’ when
liberals objected to an appearance of BNF President <span style="color: #0070c0;"><a href="http://en.wikipedia.org/wiki/Question_Time_British_National_Party_controversy">Nick Griffin</a></span>. But when the
programme went ahead and Griffin disgraced himself with his poor arguments,
those very same critics changed their minds and applauded the decision to let
him have his say.<o:p></o:p></span></span></div>
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<span lang="EN-US"><span style="font-family: Georgia, Times New Roman, serif;">Perhaps Griffin represented
something of a twilight position – a member of a despised out group whose views
are held to be repugnant by many. Yet his position as leader of a party which
enjoyed a certain amount of support, earned him the right to be entertained by
a public broadcaster. Thus, Griffin held something of an ‘out/in’ position that
confused us. <o:p></o:p></span></span></div>
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<span lang="EN-US"><span style="font-family: Georgia, Times New Roman, serif;">Tolerance for the beliefs
of others does not mean we have to share them. It simply means that we
understand that certain ideas are meaningful to others, even if we can’t
possibly agree, or even despise them. Many make the mistake of believing that
where ideas cannot be shared, there can be no tolerance. It is true that some
ideas will be offensive, others plain ignorant. In these cases, all that we
will be able to respect is the individual right to free expression - that is
indeed difficult, but it is surely enough. </span></span><span lang="EN-US"><o:p></o:p></span></div>
CCCU Applied Psychologyhttp://www.blogger.com/profile/12127528347937708211noreply@blogger.com1tag:blogger.com,1999:blog-3737633890176949647.post-54596673643885566562014-12-12T13:29:00.001+00:002014-12-15T11:39:00.541+00:00We need brave people to speak out<div style="box-sizing: border-box; font-size: 14px; line-height: 20px; margin-bottom: 10px;">
<span style="font-family: Georgia, Times New Roman, serif;"><i style="background-color: #f3f3f3;"><a href="http://discursiveoftunbridgewells.blogspot.co.uk/search/label/Angela%20Gilchrist%20%28Author%29">Angela Gilchrist</a> on the launch of ‘<a href="https://www.bps.org.uk/system/files/user-files/Division%20of%20Clinical%20Psychology/public/understanding_psychosis_-_final_19th_nov_2014.pdf">Understanding Psychosis and Schizophrenia</a>’ , a new report from the British Psychological Society</i></span></div>
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<span style="font-family: Georgia, Times New Roman, serif;"><i style="background-color: #f3f3f3;"><br /></i></span></div>
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEim-kQrXDQLWaTM7Lu3ul2TG-F0ibwogpct7jYMvVj4_YKDYkTFKzjCNIuhb2rwVZ9bTvjdcB9N2fbxJYaL7xj8YoR-EEUhuEB0G8KqjY_Eu0n71QBgjnpEPkDPDNpo6L4Lm5UTX_-aoyHc/s1600/Understanding+Psychosis+Cover.jpg" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><span style="background-color: #f3f3f3;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEim-kQrXDQLWaTM7Lu3ul2TG-F0ibwogpct7jYMvVj4_YKDYkTFKzjCNIuhb2rwVZ9bTvjdcB9N2fbxJYaL7xj8YoR-EEUhuEB0G8KqjY_Eu0n71QBgjnpEPkDPDNpo6L4Lm5UTX_-aoyHc/s1600/Understanding+Psychosis+Cover.jpg" height="200" width="140" /></span></a></div>
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<span style="background-color: #f3f3f3; font-family: Georgia, Times New Roman, serif;">This is a critical moment in mental health history: never have so many decision makers wanted things to change. That’s according to the National Clinical Director for Mental Health, <a href="http://www.england.nhs.uk/tag/geraldine-strathdee/">Dr Geraldine Strathdee</a>, speaking last week at the launch of ‘Understanding Psychosis and Schizophrenia', a report from the British Psychological Society’s Division of Clinical Psychology.</span></div>
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<span style="background-color: #f3f3f3; font-family: Georgia, 'Times New Roman', serif;">The event, described by many as 'ground-breaking and momentous', was remarkable in that it brought together numerous and disparate voices in the mental health community including psychiatrists, psychologists, policy makers, third sector workers and people with lived experience of psychosis. Among the guests were the Shadow Minister for Public Health and Mental Health, Luciana Berger; and the founder and principal theorist for the <a href="http://www.hearing-voices.org/">Hearing Voices Movement</a>, Professor Marius Romme.</span></div>
<a name='more'></a><br />
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<span style="background-color: #f3f3f3; font-family: Georgia, Times New Roman, serif;">Dr Strathdee said mental health issues would not go forward unless more voices were heard. 'We need government to act to do things about mental health. We need brave people to speak out. We need the voice of every psychological therapist in the room to get louder', Dr Strathdee said. She added that there were 'prevailing myths' about mental health that needed to be countered. These myths included the idea that people were born with mental health problems, that there were no treatments for them and that they were always long-term conditions.</span></div>
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<span style="background-color: #f3f3f3; font-family: Georgia, Times New Roman, serif;">The Editor of the report, Clinical Psychologist <a href="http://discursiveoftunbridgewells.blogspot.co.uk/search/label/Anne%20Cooke%20%28Author%29">Anne Cooke</a>, said the document was written as an attempt to 'change society's approach to psychosis and to end 'compulsory illness thinking'.</span></div>
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<span style="background-color: #f3f3f3; font-family: Georgia, Times New Roman, serif;">Service users who had lived experience of psychosis contributed a quarter of the 175 pages of the report, which sets out to demystify psychotic experiences in everyday language. Speaking loudly to the psychological and social aspects of psychotic experiences, the crux of the document is that thinking of psychosis as an illness is not the only way to view these phenomena, said Ms Cooke.</span></div>
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<span style="background-color: #f3f3f3; font-family: Georgia, Times New Roman, serif;">DCP UK Chair, Richard Pemberton, said the publication of the report was an important step for the profession. 'It feels as if things are shifting - there is an opportunity here and we need to grab it', he said.</span></div>
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<span style="background-color: #f3f3f3; font-family: Georgia, Times New Roman, serif;">One of the most moving testimonies of the day came from survivor and activist, <a href="http://www.jacquidillon.org/">Jacqui Dillon</a>, who spoke in mythic terms of her own struggle with psychosis and subsequent healing. Other speakers, including Psychiatric survivor and Clinical Psychologist <a href="http://www.rufusmay.com/">Dr Rufus May</a>, pointed to the meanings in psychosis and how these need to be understood and integrated. Service users and 'voice hearers' such as Rai Waddingham from ISPS UK, Mind in Camden and the Hearing Voices Network, spoke of their recovery journeys and how they had learned to live alongside voices and use these as a resource for their lives.</span></div>
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<span style="background-color: #f3f3f3; font-family: Georgia, Times New Roman, serif;">Leading psychosis researcher, <a href="https://www.liv.ac.uk/psychology-health-and-society/staff/richard-bentall/">Professor Richard Bentall</a>, gave the audience an engaging 'whistle stop tour' through 30 years of psychosis research in psychology. At the heart of psychosis research was the discovery that there were no such genes as schizophrenia genes, and neither were the so called 'mental illnesses' separate or discrete entities. He said what was most important to service users was hope and self-esteem, adding that it was a pity that the media showed little interest in the social determinants of mental illness.</span></div>
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<span style="background-color: #f3f3f3; font-family: Georgia, Times New Roman, serif;">The chair of the Schizophrenia Commission and a fellow of the Royal College of Psychiatrists, <a href="https://kclpure.kcl.ac.uk/portal/robin.murray.html">Professor Sir Robin Murray</a>, said it was time for Clinical Psychologists to do more than 'look after their own patch'. He had 'no doubt' that psychological approaches such as CBT benefitted patients. This approach had altered the way in which psychiatrists thought about psychosis, he said. Professor Murray added that he would have been proud if the RCP had produced the report.</span></div>
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<div style="box-sizing: border-box; font-size: 14px; line-height: 20px; margin-bottom: 10px;">
<span style="font-family: 'Times New Roman', serif; font-size: 12pt;"><span style="background-color: #f3f3f3;"><i>This piece was originally published by <a href="https://thepsychologist.bps.org.uk/we-need-brave-people-speak-out">The Psychologist</a> for the British Psychological Society. It is reproduced here with permission.</i> </span><br />
<!--[endif]--></span></div>
CCCU Applied Psychologyhttp://www.blogger.com/profile/12127528347937708211noreply@blogger.com0tag:blogger.com,1999:blog-3737633890176949647.post-74214904223866051822014-10-27T11:57:00.000+00:002014-10-27T13:14:01.786+00:00Robin Williams, depression and the complex causes of suicide<i>While many people who kill themselves have been experiencing the extreme
distress we might think of as depression, that’s not always the case
and is rarely the whole explanation. </i><br />
<i><br /></i>
<i>This article originally appeared on the <a href="http://www.theguardian.com/science/blog/2014/aug/18/robin-williams-depression-causes-suicide">Guardian Science Website</a> on the 18th of August 2014 and is reproduced here with permission.</i><br />
<i><br /></i>
<i><a href="http://discursiveoftunbridgewells.blogspot.co.uk/search/label/Anne%20Cooke%20%28Author%29">Anne Cooke</a>, <a href="http://discursiveoftunbridgewells.blogspot.co.uk/search/label/Angela%20Gilchrist%20%28Author%29">Angela Gilchrist</a> and <a href="http://discursiveoftunbridgewells.blogspot.co.uk/search/label/John%20McGowan%20%28Author%29">John McGowan</a></i><br />
<span style="font-family: Georgia, Times New Roman, serif;"><br /></span>
<span style="font-family: Georgia, Times New Roman, serif;"><br /></span>
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<tr><td class="tr-caption" style="text-align: center;"><span style="font-size: xx-small;">Photo: Eva Rinaldi</span></td></tr>
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<span style="font-family: Georgia, Times New Roman, serif;">As the tributes to the actor and comedian Robin Williams continue, so
too do the arguments over the meaning of his death. Suicide is a
profound act that touches many, and it would be surprising if it didn’t
raise strong feelings. On the one hand we have Shep Smith of Fox News
calling Williams a “<a href="http://www.slate.com/blogs/the_slatest/2014/08/12/robin_williams_suicide_fox_news_host_calls_actor_s_actions_cowardly_apologizes.html">coward</a>”
(he has since apologised). On the other we have a range of articles
defending the star, usually along the lines of “don’t blame the guy – he
had a mental illness.”</span><br />
<span style="font-family: Georgia, Times New Roman, serif;"><br /></span>
<span style="font-family: Georgia, Times New Roman, serif;">Most of the coverage has encouraged us to see his anguish as a
symptom of a sickness as real and biologically based as measles or a
broken leg. Just like those afflictions, we’re told, depression can
strike anyone out of the blue. A <a href="http://www.theguardian.com/science/brain-flapping/2014/aug/12/robin-williams-suicide-and-depression-are-not-selfish">piece by Guardian science blogger Dean Burnett</a>
offered a variation on this theme, asserting that depression is an
illness and attacking any suggestion that suicidal acts might involve
anything but desperation and a wish to escape. While we’re sure that the
piece was written with the intention of defending someone in pain, we
worry that it contains ways of thinking about mental health that
oversimplify complex issues and can be unhelpful.</span><br />
<a name='more'></a><br />
<span style="font-family: Georgia, 'Times New Roman', serif;"><br /></span>
<span style="font-family: Georgia, 'Times New Roman', serif;">The most pervasive of these ideas is the suggestion that the way
depressed people behave is a result of faulty brain chemistry. On the
face of it, this is a good alternative to blaming them for being weak in
some way: psychologist Mary Boyle has called this the “</span><a href="http://www.thepsychologist.org.uk/archive/archive_home.cfm/volumeID_20-editionID_147-ArticleID_1184-getfile_getPDF/thepsychologist%5C0507dia1.pdf" style="font-family: Georgia, 'Times New Roman', serif;">blame or brain</a><span style="font-family: Georgia, 'Times New Roman', serif;">”
approach to troublesome emotions, behaviours and psychological
experiences. However, what we often lose sight of is that calling
certain emotional states or ways of thinking and acting “mental
illnesses” is just </span><a href="http://discursiveoftunbridgewells.blogspot.co.uk/2013/02/im-sicker-than-i-thought-i-was.html" style="font-family: Georgia, 'Times New Roman', serif;">one way of thinking</a><span style="font-family: Georgia, 'Times New Roman', serif;"> about them, rather than the only way.</span><br />
<span style="font-family: Georgia, Times New Roman, serif;"><br /></span>
<span style="font-family: Georgia, Times New Roman, serif;">It may well be that some of us are more vulnerable than others to
feeling desperate, but this is likely to be a result of things that have
happened in our lives rather than, or perhaps sometimes in addition to,
our genetic makeup. All we really know is that people sometimes feel or
act in certain ways. The rest is down to interpretation. </span><br />
<span style="font-family: Georgia, Times New Roman, serif;"><br /></span>
<span style="font-family: Georgia, Times New Roman, serif;">If you feel sad and hopeless, and stay in bed all day staring at the
ceiling, you might well be diagnosed with depression. Being told that
you have an illness has its advantages. You can go to your GP and
hopefully find a sympathetic ear, make some sense of what’s going on,
get medication to take the edge off things and perhaps be referred to a
specialist you can talk to. If you can’t work, you can take time off
sick. </span><br />
<span style="font-family: Georgia, Times New Roman, serif;"><br /></span>
<span style="font-family: Georgia, Times New Roman, serif;">But there are downsides too. Thinking of yourself as mentally ill
might well be a huge blow to your self-confidence. You might conclude
that there is little you can do to help yourself except to keep taking
the tablets. You might even worry that you are genetically inferior in
some way. Mental illness still has many <a href="https://catalogue.ic.nhs.uk/publications/mental-health/legislation/atti-ment-illn-2011/atti-ment-illn-2011-sur-rep.pdf">negative associations</a> in the public mind. This can lead to what psychologist Rufus May has described as <a href="http://www.madinamerica.com/author/rmay/">“us and them” thinking</a>
– the idea that there are two groups of people in the world: those of
us who are well, and those who are mentally ill and therefore different
in some way. </span><br />
<span style="font-family: Georgia, Times New Roman, serif;"><br /></span>
<span style="font-family: Georgia, Times New Roman, serif;">Lurking in the background is the spectre of the Mental Health Act:
people with “mental disorders” are the only group that can be locked up
without trial and medicated against their will, even if they are deemed
capable of making decisions for themselves.</span><br />
<span style="font-family: Georgia, Times New Roman, serif;"><br /></span>
<span style="font-family: Georgia, Times New Roman, serif;">Perhaps the biggest problem with the illness idea, though, is that it
can stop us trying to understand the broader context: the events and
circumstances of our lives and how we respond to them. The truth is that
we’re all vulnerable to mental health problems given the right
circumstances. And we never know when those circumstances might befall
us, pitching us towards a tipping point that we hadn’t perceived to be
there.</span><br />
<span style="font-family: Georgia, Times New Roman, serif;"><br /></span>
<span style="font-family: Georgia, Times New Roman, serif;">Those who live ordinary lives may find it hard to fathom that someone
like Robin Williams could be miserable enough to want to die. We forget
that celebrity inevitably brings its own problems. And once you’ve
reached a star-studded pinnacle, there’s nowhere to go but down. Even
before we learned that he had been <a href="http://www.theguardian.com/film/2014/aug/14/robin-williams-parkinsons-disease">diagnosed with Parkinson’s disease</a>,
we didn’t have to look far to find possible causes of profound sadness
in Robin Williams’ life. He had acknowledged difficulties with both
drugs and alcohol, the latter being a factor in one of his two divorces.
And he was in financial difficulty, something that had him taking TV
and film roles he would have <a href="http://www.mirror.co.uk/3am/celebrity-news/robin-williams-looked-terrible-tormented-4042507">preferred not to have taken</a>.</span><br />
<span style="font-family: Georgia, Times New Roman, serif;"><br /></span>
<span style="font-family: Georgia, Times New Roman, serif;">The truth is that suicide is complicated, and the combination of
circumstances, emotions and motivations that precede a suicide attempt
will be different for each person. While many people who kill themselves
have been experiencing the extreme distress we might think of as
depression, that’s not always the case and is rarely the whole
explanation. </span><br />
<span style="font-family: Georgia, Times New Roman, serif;"><br /></span>
<span style="font-family: Georgia, Times New Roman, serif;">People have been known to kill themselves as a consequence of intense
shame, or because they see no way out of a moral dilemma or a future
that appears bleak. Many who attempt suicide may not really want to die,
but seek instead to escape unbearable psychic pain. There are those
with ongoing difficulties who may, in part – and perhaps misguidedly
given the often profound effect of a suicide on the person’s family – be
seeking to release another from what they see as a burden. </span><br />
<span style="font-family: Georgia, Times New Roman, serif;"><br /></span>
<span style="font-family: Georgia, Times New Roman, serif;">And although it may be uncomfortable to think about, for some people
the motivations may involve anger as well as desperation. It is
important to be open to the range of meanings of a suicidal act and to
acknowledge that those left behind may also experience complex and
sometimes bitter feelings.</span><br />
<span style="font-family: Georgia, Times New Roman, serif;"><br /></span>
<br />
<span style="font-family: Georgia, Times New Roman, serif;">Invoking the idea of illness can sometimes be helpful, but it isn't the only way of connecting to people’s despair and of offering
compassion and help without making value judgements. An alternative is
simply to recognise that people can have a tough time. Surely that
should be enough.</span><br />
<span style="font-family: Georgia, Times New Roman, serif;"><br /></span>
<span style="font-family: Georgia, Times New Roman, serif;"><em>The authors work at the <a href="http://www.canterbury.ac.uk/social-and-applied-sciences/salomons-centre-for-applied-psychology/salomons-centre-for-applied-psychology.aspx">Salomons Centre for Applied Psychology, Canterbury Christ Church University</a></em><em>. A longer discussion of issues related to the idea of mental illness can be found <a href="http://discursiveoftunbridgewells.blogspot.co.uk/2013/09/is-life-disease.html">here</a>. </em><em>An audio slideshow about the complexities of suicidal risk is available <a href="https://www.youtube.com/watch?v=01HOIa3skVA">here</a>.</em></span><br />
<span style="font-family: Georgia, Times New Roman, serif;"><em><br /></em></span>
<em><span style="font-family: Georgia, Times New Roman, serif;">Dean Burnett (mentioned in the article above) also wrote a response <a href="http://deansnonscienceblog.tumblr.com/post/95181602155/robin-williams-suicide-and-depression-criticism-and">here</a>.</span></em><br />
<em><span style="font-family: Georgia, Times New Roman, serif;"><br /></span></em>
<br />
<em><span style="font-family: Georgia, Times New Roman, serif;">In the US, the <a href="http://www.suicidepreventionlifeline.org/">National Suicide Prevention Hotline</a> is 1-800-273-8255. In the UK, the <a href="http://www.samaritans.org/">Samaritans</a> can be contacted on 08457 90 90 90. In Australia, the crisis support service <a href="https://www.lifeline.org.au/">Lifeline</a> is on 13 11 14</span></em><br />
<em><span style="font-family: Georgia, Times New Roman, serif;"><br /></span></em>
<em><span style="font-family: Georgia, Times New Roman, serif;">Dean Burnett (mentioned in the article above) also wrote a response <a href="http://deansnonscienceblog.tumblr.com/post/95181602155/robin-williams-suicide-and-depression-criticism-and">here</a>.</span></em>CCCU Applied Psychologyhttp://www.blogger.com/profile/12127528347937708211noreply@blogger.com1tag:blogger.com,1999:blog-3737633890176949647.post-62508097468614196582014-09-24T17:44:00.001+01:002014-09-25T10:15:08.404+01:00Electroconvulsive Therapy: Whose decision is it?<div class="MsoNormal">
<b><i><span style="font-family: inherit;">@steweatherhead
& @THEAGENTAPSLEY<o:p></o:p></span></i></b></div>
<div align="center" class="MsoNormal" style="text-align: center;">
<span style="font-family: inherit;"><br /></span></div>
<table cellpadding="0" cellspacing="0" class="tr-caption-container" style="float: left; text-align: left;"><tbody>
<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjkSAGdDFBiJ_0vJIEfjPrfqhvpGQEQKUHL-Yz0erooHe_7wIVt3_Q-2_f9-oZVzox36G9hzec98b01dxiJlC9Ww8ZE5bmjfQhaWLCHQMHBLF3DFBziXNyzz4dFv4IJSERY1ejUYg7af3u5/s1600/consent.png" imageanchor="1" style="clear: left; margin-bottom: 1em; margin-left: auto; margin-right: auto;"><span style="font-family: inherit;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjkSAGdDFBiJ_0vJIEfjPrfqhvpGQEQKUHL-Yz0erooHe_7wIVt3_Q-2_f9-oZVzox36G9hzec98b01dxiJlC9Ww8ZE5bmjfQhaWLCHQMHBLF3DFBziXNyzz4dFv4IJSERY1ejUYg7af3u5/s1600/consent.png" height="89" width="200" /></span></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;"><span style="font-family: inherit; font-size: xx-small;">What does consent to treatment mean?</span></td></tr>
</tbody></table>
<div class="MsoNormal">
<i><span style="font-family: inherit;">Lisa is a 42
year-old woman. She has had a difficult life. She has experienced multiple
traumas and has at times struggled with her emotions. Lisa has a few close
family members and a small social circle, though she does at times feel a bit
oppressed by them. In 2010 Lisa contracted HIV. She has been treated medically
and was stable for some time, however in 2013 she started to deteriorate. She
was seen by a psychologist as well as by medics. After a further twelve months
she had had enough of interventions and decided she wanted to live the
remainder of her life in her own way. Her family and friends objected as they
could see she would rapidly deteriorate. However with support from
professionals, Lisa utilised the Mental Capacity Act (MCA) to set some advanced
directives. She was found to be capable of making these decisions under the
MCA, and was legally allowed to refuse further intervention. Lisa did indeed
deteriorate, and died a few months later in her own home with her family and
friends around her.</span></i></div>
<a name='more'></a><span style="font-family: inherit;"><i><o:p></o:p></i><br /></span>
<br />
<div class="MsoNormal">
<span style="font-family: inherit;">Here’s
another version of that story:</span></div>
<div class="MsoNormal">
<span style="font-family: inherit;"><o:p></o:p></span></div>
<div class="MsoNormal">
<span style="font-family: inherit;"><br /></span></div>
<div class="MsoNormal">
<span style="font-family: inherit;"><i>Lisa is a 42
year-old woman. She has had a difficult life. She has experienced multiple
traumas and has at times struggled with her emotions. Lisa has a few close family members and a
small social circle, though she does at times feel a bit oppressed by them. In
2010 Lisa was diagnosed with Depression. She has been treated medically and was
stable for some time, however in 2013 she started to deteriorate. She was seen
by a psychologist as well as by medics. After a further twelve months she had
had enough of interventions and decided she wanted to live the remainder of her
life in her own way. Her family and friends objected as they could see she
would rapidly deteriorate. However with support from professionals, Lisa
utilised the </i><a href="http://www.legislation.gov.uk/ukpga/2005/9/contents"><i>Mental
Capacity Act</i></a><i> (MCA) to set some
advanced directives. She was found to be capable of making these decisions
under the MCA, and was legally allowed to refuse further intervention. Lisa did
indeed deteriorate, and the professionals over-ruled Lisa’s decision and
treated her with Electro-Convulsive Therapy (ECT).<o:p></o:p></i></span></div>
<div class="MsoNormal">
<span style="font-family: inherit;"><br /></span></div>
<div class="MsoNormal">
<span style="font-family: inherit;">These are
fictional stories but according to our current systems, this is how they could
(and probably would) play out. The only difference between them is that with
one there is a medical diagnosis and with the other there is a mental health
diagnosis. However, this detail leads to a wholly different intervention. In
the first, Lisa is permitted to die in her own way, in the other her decisions
are over-ruled. So why the difference?<o:p></o:p></span></div>
<div class="MsoNormal">
<br /></div>
<table cellpadding="0" cellspacing="0" class="tr-caption-container" style="float: left; margin-right: 1em; text-align: left;"><tbody>
<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEi9uVR3Uz4sgI0zq1lSukIUaQpXsbyt6H4HfUDD04iA0gqo4VwjFFa7AMe72b5DGWR2JEArRRzyLlwbZcagYs20-jUN2-X9DA3v64sMuhOYnIRUfa4CTTkjmGXdDNkdBjDRwYc3cBAJJd6M/s1600/electrocrystal1.jpg" imageanchor="1" style="clear: left; margin-bottom: 1em; margin-left: auto; margin-right: auto;"><span style="font-family: inherit;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEi9uVR3Uz4sgI0zq1lSukIUaQpXsbyt6H4HfUDD04iA0gqo4VwjFFa7AMe72b5DGWR2JEArRRzyLlwbZcagYs20-jUN2-X9DA3v64sMuhOYnIRUfa4CTTkjmGXdDNkdBjDRwYc3cBAJJd6M/s1600/electrocrystal1.jpg" height="136" width="200" /></span></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;"><span style="font-family: inherit; font-size: xx-small;">An ECT machine. Should consent <br />always be required?</span></td></tr>
</tbody></table>
<div class="MsoNormal">
<span style="font-family: inherit;">In medical
settings a person can give an advanced instruction that they do not want
further treatment even if their life is at risk. If they lose the ability to
make decisions, the MCA protects their right not to be treated. In mental
health settings a person’s similarly expressed preference can be over-ruled if
two doctors agree that the person’s life is at risk and appropriate emergency
treatments (ECT is deemed as one) can be implemented. The Mental Capacity
Act gives people the right to refuse treatment, even if that treatment may save
a person’s life. That’s <i>unless</i> that
person has been given a psychiatric diagnosis. In the case of a mental health
problem a range of treatments (including ECT) can potentially be given without their consent.</span></div>
<div class="MsoNormal">
<span style="font-family: inherit;"><br /></span></div>
<div class="MsoNormal">
<span style="font-family: inherit;"><o:p></o:p></span></div>
<div class="MsoNormal">
<span style="font-family: inherit;">This issue
has come to the fore because of a <a href="http://www.rcpsych.ac.uk/pdf/ECTAS%20Minimum%20Dataset%20Report%202012-13.pdf">recent
report</a> which
showed that of the 832 people who received ECT whilst detained, in 2012-13, 695
were found to lack the capacity to consent to that treatment.<o:p></o:p></span></div>
<div class="MsoNormal">
<span style="font-family: inherit;"><br /></span></div>
<div class="MsoNormal">
<span style="font-family: inherit;">Let’s
return to the example of Lisa. HIV being an immunodeficiency virus, can often
have no initial noticeable symptoms, lying dormant before gradually destroying
the immune system. It can be up to 20 years before the signs of AIDS develop.
The body becomes gradually unable to tolerate infection and with time, there are
an increasing number of infections. Treatment can become more and more intense,
as can its side effects.
In the later stages there is often decline in cognitive functioning and
physical deterioration, leading to death.<o:p></o:p></span></div>
<div class="MsoNormal">
<span style="font-family: inherit;"><br /></span></div>
<div class="MsoNormal">
<span style="font-family: inherit;">When a
person is diagnosed with a mental health problem, such as depression, the situation is different. A range of treatments may be offered,
including talking therapy and medication. Time may be given for amelioration
in the symptoms. However, if difficulties progressed and a person perhaps began to
harm themselves or had the inclination and plan to kill themselves, they may be
admitted to a mental health inpatient setting. Medication would often increase.
If no improvement were noted and the person’s life perceived to be in danger,
ECT may be considered. <o:p></o:p></span></div>
<div class="MsoNormal">
<span style="font-family: inherit;"><br /></span></div>
<div class="MsoNormal">
<span style="font-family: inherit;">The most
important aspect of the contrast between these two scenarios is that, when
someone is diagnosed with a specifically mental health related problem the <a href="http://www.legislation.gov.uk/ukpga/2007/12/contents">Mental Health Act
(2007)</a> may be
applied. Under the Mental Health Act (MHA)
consent to treatment for mental health problems is not necessarily required. While the
courts have upheld the rights of a person detained under the MHA to refuse
treatment for a tumour, the same person can be forced to have medication (by
injection) for psychosis. This has become the norm for mental
health, in stark contrast to the application of the Mental <i>Capacity </i>Act to any other area of care. We have seen legal
precedents for many areas of the MCA, including Deprivation of Liberty cases in
mental health settings. However, we are not aware of a test case where someone
has set excellent advanced directives , setting out their wishes upon
deterioration, and stating that under no circumstances do they want to receive
ECT.<o:p></o:p></span></div>
<div class="MsoNormal">
<span style="font-family: inherit;"><br /></span></div>
<div class="MsoNormal">
<span style="font-family: inherit;">The recent
data on ECT was staggering in terms of how many people were deemed to lack
capacity, when the considerations of the MHA come into play. There is
work to be done here; we need to see how law courts test the issue. However,
regardless of this, there is room for service improvement if the MCA can be
introduced better into mental health systems. Could we perhaps move towards a
system where we just use the MCA as a total replacement of the MHA?<o:p></o:p></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span style="font-family: inherit;">We can certainly
safely propose change in the implementation of the MCA in mental health
settings without harm to services; in fact it would improve service provision!
Claiming that patients do not have capacity can be easy. Staying true to the
empowering ethos of the MCA is harder. It can feel harder still to allow a
person to reject an intervention which the professional feels could save their
life. Think back to the scenarios set out for Lisa at the beginning of this
article and ask yourself why ECT is treated differently. <span style="line-height: 115%;">We
need transparency of process and more effort to go beyond minimum requirements,
instead exemplifying best practice in the implementation of the MCA. As things
stand, we often don’t know after the ECT, whether or not a person had the
capacity to decide at some point during their involvement with services to give
advanced directives in relation to the treatment.</span><span style="line-height: 115%;"> </span>The MCA MUST be implemented better, and we SHOULD be incorporating
advanced directives for ECT at a very early point, before the deterioration
which can lead to ECT being considered. Failing to do so is failing the people
we should be caring for.</span><o:p></o:p></div>
CCCU Applied Psychologyhttp://www.blogger.com/profile/12127528347937708211noreply@blogger.com20tag:blogger.com,1999:blog-3737633890176949647.post-49977656436567184632014-07-24T10:01:00.001+01:002014-07-24T10:06:18.499+01:00Guest post: But they look like you and me!<div class="MsoNormal">
<i><span lang="EN-US">Jo Mueller
investigates how parents could hold the key to tackling mental health stigma<o:p></o:p></span></i></div>
<div class="MsoNormal">
<br /></div>
<table cellpadding="0" cellspacing="0" class="tr-caption-container" style="float: left; margin-right: 1em; text-align: left;"><tbody>
<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjt_OazRp4Swfd9q_n0AblfOaH4fg9FTUvXE0YUzQ2wv0PDi0KnAtHKtxXDURxx_5vdq5kCg6IN8AQg-1UYiVfRy_wdcks7_pWHRDfVmWaU11vAsKYSKKJXRDItsvzvOXCvONcR6SiE70dG/s1600/Child+and+alien.jpg" imageanchor="1" style="clear: left; margin-bottom: 1em; margin-left: auto; margin-right: auto;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjt_OazRp4Swfd9q_n0AblfOaH4fg9FTUvXE0YUzQ2wv0PDi0KnAtHKtxXDURxx_5vdq5kCg6IN8AQg-1UYiVfRy_wdcks7_pWHRDfVmWaU11vAsKYSKKJXRDItsvzvOXCvONcR6SiE70dG/s1600/Child+and+alien.jpg" height="200" width="180" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;"><span style="font-size: xx-small;">Alien? Or simply struggling? Views about<br />mental health are formed early.<br />Photo: <a href="https://www.flickr.com/photos/nadja_robot/">nadja robot</a></span></td></tr>
</tbody></table>
<div class="MsoNormal">
<span lang="EN-US"><span style="font-family: Georgia, Times New Roman, serif;">When it comes to attitudes to mental health,
things are getting worse. Despite the high-profile campaigns, stigma and
discrimination against people with mental health problems seem to be <a href="https://catalogue.ic.nhs.uk/publications/mental-health/legislation/atti-ment-illn-2011/atti-ment-illn-2011-sur-rep.pdf">on the rise</a>.
Part of the reason may be that our campaigns are promoting the <a href="http://discursiveoftunbridgewells.blogspot.co.uk/2014/01/flo-bellamy-does-diagnosis-simply.html">wrong</a> <a href="http://discursiveoftunbridgewells.blogspot.co.uk/2013/05/when-ads-dont-work.html">message</a>.
The way we often address stigma is to promote the idea that mental health
problems are illnesses<i>. </i>The rationale
is noble. Rather than give the impression that someone <a href="http://discursiveoftunbridgewells.blogspot.co.uk/2013/09/is-life-disease.html">is weak or
blameworthy</a>, isn’t it surely better to say they are sick?<o:p></o:p></span></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span lang="EN-US"><span style="font-family: Georgia, Times New Roman, serif;">The danger of this is that the idea of something
going wrong with people’s brains can be scary and alienating<i>. </i>Put this together with the ‘<a href="http://www.time-to-change.org.uk/talk-about-mental-health">1 in 4</a>’ idea
- that one in four of us will suffer ‘mental illness’ at some point - and it can
add up to a frightening message: there’s a dangerous disease out there that
might strike at us any time.</span></span></div>
<a name='more'></a><span style="font-family: Georgia, Times New Roman, serif;"> <o:p></o:p></span><br />
<div class="MsoNormal">
<span lang="EN-US"><span style="font-family: Georgia, Times New Roman, serif;"> </span></span><span style="font-family: Georgia, 'Times New Roman', serif;">However, we all have dark moments, and many
argue those are on the same spectrum as the emotional distress that attracts
‘mental health’ diagnoses. As clinical psychologist Anne Cooke </span><a href="http://www.bps.org.uk/news/stigma-and-mental-health-treatment" style="font-family: Georgia, 'Times New Roman', serif;">said recently</a><span style="font-family: Georgia, 'Times New Roman', serif;">,
‘</span><i style="font-family: Georgia, 'Times New Roman', serif;">there is no “us and them”, no people who
are ‘normal’ and people who are “mentally ill”. We’re all in this together.’</i></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span lang="EN-US"><span style="font-family: Georgia, Times New Roman, serif;">Just as important as the message though, is
the question of whether the wide-focus approach of anti-stigma campaigns (posters
on the tube, etc.) is the most effective way to go about things. So what
messages should we be giving and who are the most important groups to reach?<o:p></o:p></span></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span lang="EN-US"><span style="font-family: Georgia, Times New Roman, serif;">A <a href="http://www.emeraldinsight.com/journals.htm?issn=1746-5729&volume=13&issue=1&articleid=17105257&show=html">study</a> that
I and some colleagues have recently published investigated both the message and
the people who receive it. In particular, we looked at the importance of communication
during key stages of children’s development and we considered how parents talk
to their primary-school-aged children about mental health. <o:p></o:p></span></span></div>
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<br /></div>
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<span lang="EN-US"><span style="font-family: Georgia, Times New Roman, serif;">Our central finding was that, while parents
were happy and open when chatting to their children about mental <i>wellbeing</i>, the exact opposite was true
when communicating about mental <i>illness</i>.
The more parents thought of a particular issue as being about mental illness,
the more they conceptualised it as happening to other people and the less they talked
to their child about it. Even when asked directly, parents tended to avoid the
subject. Comments often inadvertently reinforced the us and them distinction: ‘<i>He’s met a girl who is bipolar but I don't
think he realised…. they look like you and me</i>’. <o:p></o:p></span></span></div>
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<br /></div>
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<span lang="EN-US"><span style="font-family: Georgia, Times New Roman, serif;">Interestingly, the parents in the study all
said that they wanted to be open and honest with children about mental health
problems. The mismatch with what they actually did led to some interesting contradictions.
For example, parents believed that their children were understanding and accepting
of mental illness. However, they also talked about children’s lack of
understanding and the probability of them being upset as reasons to avoid talking
about it. Most poignantly, these confusions were even true of parents who had
themselves experienced mental health problems: <o:p></o:p></span></span></div>
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<span style="font-family: Georgia, Times New Roman, serif;"><i><span lang="EN-US">‘I don't think you put your head in the sand and
pretend it’s not there. … I got post-natal depression… and Daisy [name changed]
went through that. Now, I’ve never told her I had depression.’</span></i><span lang="EN-US"><o:p></o:p></span></span></div>
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<span lang="EN-US"><span style="font-family: Georgia, Times New Roman, serif;">The way parents talked to their children
was powerfully influenced by the way that their own parents had talked to them.
Often people wanted to be more open than their own parents had been, but didn’t
manage it. I wonder if this affects many families. There was a sobering moment
halfway through the research when I realised that this issue had been a part of
my own childhood. I remember half-explanations, pointed looks, and sad voices when
people mentioned a beloved family member who had died before I was born. Much later
on, I discovered that they had died by suicide, following a period of intense
mental distress. When I plucked up the courage to broach this with my family, I
found that my parents hadn’t talked to me about it partly because they felt
they hadn’t really understood what had gone on. They put this down to silence
on the subject on the part of their own parents. Taboo and lack of
understanding had passed down through the generations.<o:p></o:p></span></span></div>
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<span lang="EN-US"><span style="font-family: Georgia, Times New Roman, serif;">Why is it important to know what messages
parents are giving to their children?<o:p></o:p></span></span></div>
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<span lang="EN-US"><span style="font-family: Georgia, Times New Roman, serif;">Our study shows that between the ages of 7
and 11 children receive messages from their parents that divide the world into us
and them. This is exactly the age when children’s brains begin to develop the
ability to understand mental health issues. It’s also <a href="http://onlinelibrary.wiley.com/doi/10.1111/j.1469-7610.2005.01456.x/full">the age</a>
when prejudice towards people with mental health problems begins. Our research
suggests that parents’ messages are contributing to the development of
stigmatising attitudes. It also suggests that unconscious intergenerational
patterns of parenting might lead to the persistence of these messages, despite wishing
for something different. This process could undermine any beneficial impact of
programmes such as <a href="http://www.time-to-change.org.uk/">Time to Change</a>,
targeting as they do explicit opinions and knowledge. It’s clear that these <i>don’t </i>translate into changed messages to
children nearly as easily as we might think.<o:p></o:p></span></span></div>
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<span lang="EN-US"><span style="font-family: Georgia, Times New Roman, serif;">So what could we do differently if explicit
messages reinforcing difference are not the best way? Here are a few
suggestions:<o:p></o:p></span></span></div>
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</div>
<ul>
<li><span style="font-family: Georgia, Times New Roman, serif;">Anti-stigma programmes should explicitly target
parents of young children. Parents are skilled at talking about mental <i>wellbeing</i> with their children. It
follows that an understanding of mental health and distress as part of a
spectrum of human experience, is likely to help parents feel more confident in openly
discussing mental health difficulties.</span></li>
<li><span style="font-family: Georgia, Times New Roman, serif;">Encourage parents to reflect on what was
communicated to them as children might help them think about what they might
like to do differently. During my research interviews parents readily began to
do this with relatively little prompting.</span></li>
<li><span style="font-family: Georgia, Times New Roman, serif;">Campaigns need to target primary school
aged children directly, in the media and also working alongside schools and
parents. Campaigns targeting adolescents and adults are too late: fear and
prejudice are already ingrained.</span></li>
<li><span style="font-family: Georgia, Times New Roman, serif;">We shouldn’t rely upon campaigns and professionals
to begin this sea change. Each of us can start to make changes to how we talk
about mental distress within our own families. Take a risk: bring it up. Let’s help
our children learn that there is no us and them, only us and us.</span></li>
</ul>
<div>
</div>
<br />
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<i><span lang="EN-US"><span style="font-family: Georgia, Times New Roman, serif;">Jo Mueller is a clinical psychologist working with
children and families in London. Follow her on Twitter <a href="https://twitter.com/clinpsydrjo">@clinpsydrjo</a>.</span><o:p></o:p></span></i></div>
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CCCU Applied Psychologyhttp://www.blogger.com/profile/12127528347937708211noreply@blogger.com1tag:blogger.com,1999:blog-3737633890176949647.post-10738628791245282612014-07-21T12:09:00.000+01:002014-07-21T12:56:39.157+01:00The winner takes it all<div class="MsoNormal" style="line-height: 150%;">
<a href="http://discursiveoftunbridgewells.blogspot.co.uk/search/label/John%20McGowan%20%28Author%29"><i>John McGowan</i></a><i> considers the horrors of school sports day and suggests a surprisingly simple remedy<o:p></o:p></i></div>
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<br /></div>
<table cellpadding="0" cellspacing="0" class="tr-caption-container" style="float: left; margin-right: 1em; text-align: left;"><tbody>
<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEj8U8KPzJ5Dyktjt9-miqrVb7PyKmLtPiivwG3ZcPdM9ck-2wk4mH0NMQgGwu1cYyPygd9ypU3KMFUTih6pky64Rkr62U8jBme-8qS2W1h29QN_T-9bwDNKbdRMulpqLptAXFOHI3LOZVlv/s1600/eggandspoonb&W.jpg" imageanchor="1" style="clear: left; margin-bottom: 1em; margin-left: auto; margin-right: auto;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEj8U8KPzJ5Dyktjt9-miqrVb7PyKmLtPiivwG3ZcPdM9ck-2wk4mH0NMQgGwu1cYyPygd9ypU3KMFUTih6pky64Rkr62U8jBme-8qS2W1h29QN_T-9bwDNKbdRMulpqLptAXFOHI3LOZVlv/s1600/eggandspoonb&W.jpg" height="148" width="200" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;"><span style="font-size: xx-small;">The loser's standing small? Photo: Alethe</span></td></tr>
</tbody></table>
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‘Well done darling! You did
brilliantly.’ As summer term draws to a
close, parents get to enact the timeless rituals of sports day. Cheer, take
photos of a sprinting child and celebrate success. The chance to shine in front
of the whole school, and mums and dads too. A good thing, no? Rolling up to my own children’s sports day
this year though, my eye was distracted by the other end of the proceedings:
the kids labouring in while the winners were posing for pictures. I swear they
were pretty much the same kids who brought up the rear last year. In fact, I
know they were. What, I wondered, is the benefit of sports day for them?</div>
<a name='more'></a><o:p></o:p><br />
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<o:p> </o:p><span style="line-height: 150%;">Before I get bracketed as an
anti-sport, anti-competition party pooper let me just clear up a couple of
things. I like sport. I think PE has </span><a href="http://www.bbc.co.uk/news/education-21449610" style="line-height: 150%;"><span style="color: #1155cc;">value</span></a><span style="line-height: 150%;">
and should be compulsory and extensive. Also, after a football-dominated youth
in Scotland, I’m in favour of PE being as varied and creative as possible.
Swimming, athletics, lacrosse, tight-rope walking: bring them on and engage the
widest range of children possible. I also like competition. Physical activity
can go on without it, of course, but something is definitely lost. Plenty of
kids like competitiveness too; trying to stop it is like asking the wind not to
blow.</span></div>
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<o:p></o:p></div>
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In attempting to unpack why the thought
of the kids who regularly lose troubled me so much, I realised it was because
they had been <i>made</i> to compete. No
choice was offered, even though (very public) defeat felt inevitable. As well
as being harsh, this is inconsistent with the way we manage other extra curricula activities.
We don’t compel all kids to sing a public solo and we don’t make it even worse by
turning that into an X-Factor style competition. Why then do all children (in
my experience at least), have to annually run, jump and carry eggs in spoons in
a community spectacle? Is there is value in compulsory humiliation?<o:p></o:p></div>
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<br /></div>
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A rapid straw poll of fellow
parents suggested polarised views about sports days. Many I asked hated the
whole thing. By way of explanation they usually added a rider about their own
school sports scarring them for life or putting them off physical activity for
decades. They clearly weren’t the people I needed to talk to. The more positive
ones (including a teacher or two), spoke in terms of learning to win and lose
and of turning defeat into a better result next time. It’s important that kids
participate they said, otherwise they’ll lose interest. Wasn’t the battle of
Waterloo won on the playing fields of Eton? OK, no-one mentioned Eton or
Waterloo, but they were there in spirit.<o:p></o:p></div>
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<br /></div>
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While I’d dismiss the notion that
public ignominy is character building right off the bat (to use a sporting
idiom), I’m intrigued by the notion that defeat can spur you to better results
and the idea that it might stimulate your interest in sporting competition. I
began to wonder whether psychological theories might throw some light on the
matter. <o:p></o:p></div>
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<br /></div>
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Behaviourism, and its founding
father B. F. Skinner, have been <a href="http://blogs.scientificamerican.com/cross-check/2012/06/01/why-b-f-skinner-like-freud-still-isnt-dead/">out
of vogue</a> for few decades. However, what Skinner did supremely well, perhaps
better than any human being before him, was to describe how rewards and
punishments keep us doing some things and make us stop doing others. Here are
three <a href="http://allpsych.com/psychology101/reinforcement.html">basic behavioural
principles</a> with some thoughts about how they apply to school sports days.<o:p></o:p></div>
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Positive Reinforcement<o:p></o:p></div>
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The formal way of referring to a
reward in behavioural theory is as a ‘positive reinforcer’. That is, something
that makes the behaviour you want to increase more likely. Sports days are a
great example. Child wins race (or jumps highest or longest) or simply enjoys
the activity or the spectacle. Any of these factors might be rewarding enough
to make sure the child engages in sport again.
<o:p></o:p></div>
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Negative Reinforcement<o:p></o:p></div>
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This is the type of
reinforcement that has confused generations of psychology undergraduates. Stay
with me though as once you understand it you’ll realise we apply it all the
time. This occurs when a behaviour (for example a child taking out the rubbish)
is followed by the removal of an aversive stimulus (such as nagging by
exasperated parents). When people suggest losing at sports day is a motivator
this, though they may not realise it, is what they mean. Being stung by loss
into doing better worked for <a href="http://discursiveoftunbridgewells.blogspot.co.uk/2013/02/gazza-lance-and-difficulties-of.html">Lance
Armstrong</a> for instance, who hated losing so much that he was willing, as we
now know, to go to extreme lengths to win. The more I think about it though, the
less convinced I am. My own education was full of teachers who used this
tactic, and I’m not aware that it ever motivated me to do anything. The wish to
get rid of the feeling of humiliation at losing may be strong, but the obstacles
to changing losing behaviour for an un-sporty kid may also be huge. It may work
for some but I suspect that, for most, the bad feelings will invoke another key
behavioural process, namely...<o:p></o:p></div>
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<br /></div>
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Punishment<o:p></o:p></div>
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Doing something that produces an unpleasant result means you don’t do it again.
For applications see prison, torture, war and much of the rest of human
history. In the case of sports day I worry that coming last over and over again
essentially gives the message that sporting competition leads to feeling awful.
The most likely outcome of this is to decrease participation in sport or
competition or group activities or perhaps all three. If you’ve volunteered to
be in a race there may still be the pain of losing but there may also be
compensations (joy in the activity, feeling good about volunteering etc). It’s
harder to see these at work when you haven’t volunteered. Those parents who declared
themselves ‘scarred’ or ‘put off’ were describing the effects of punishment.<o:p></o:p></div>
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<br /></div>
<div class="MsoNormal" style="line-height: 150%;">
When you break it down, the notion
that losing in a compulsory sporting event is beneficial is tenuous at best.
The risk of this having the opposite effect from the one intended (i.e.
participation and interest going down rather than up) seems quite high. So why
do we go on putting kids in this position? The more I think about it, the more
it puzzles me. Do teachers genuinely think it’s for the best?<o:p></o:p></div>
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<br /></div>
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When the children in my kids’ school
put on a play not all of them want to go on stage. The ones who don’t want to
perform do the props, lighting and all the other backstage jobs. It seems to
work fine. In that spirit I’d like to propose a different kind of sports day: one
with proper competition sure, but where children actually opt in to the events.
And the children who don’t want to participate? Well, what if they simply don’t?
They could be referees, or scorers or just part of the crowd. Would that be so
terrible? Would we lose the spirit that built the Empire? Or would we instead
offer a more caring and humane experience of school?<o:p></o:p></div>
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<i>John
McGowan is Academic Director at the Salomons Centre for Applied Psychology. You
can follow him on Twitter <a href="https://twitter.com/CCCUAppPsy">@CCCUAppPsy</a>. <o:p></o:p></i></div>
CCCU Applied Psychologyhttp://www.blogger.com/profile/12127528347937708211noreply@blogger.com6tag:blogger.com,1999:blog-3737633890176949647.post-39402565094828053092014-06-20T13:25:00.001+01:002014-06-20T13:25:20.274+01:00Guest post: 'Schizophrenia then and now'<div class="Body">
<i><span lang="EN-US"><span style="font-family: Georgia, Times New Roman, serif;">Continuing our <a href="http://discursiveoftunbridgewells.blogspot.co.uk/2014/05/20-years-on-finally-our-myopic-brain.html">recent
reflections</a> on how things in mental health have changed <a href="http://www.richardhallam.co.uk/">Richard Hallam</a> and Michael Bender
take the long view of schizophrenia<o:p></o:p></span></span></i></div>
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<div class="Body">
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<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgi9DYTHksVnsOfUsYwSkXdMyfV2b5FW3F7sebQqnE0XUXTEFsOfnk4Z9URCzVnmT_xOd7VgmJzpV6F-WS5bt_-wjjiAQZXnau3AiGGc_2g5-SWGpW3zrvtcFQDRjRMtlRsK0nVZ1BMAiYW/s1600/One-Flew-Over-the-Cuckoos-001.jpg" imageanchor="1" style="clear: left; margin-bottom: 1em; margin-left: auto; margin-right: auto;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgi9DYTHksVnsOfUsYwSkXdMyfV2b5FW3F7sebQqnE0XUXTEFsOfnk4Z9URCzVnmT_xOd7VgmJzpV6F-WS5bt_-wjjiAQZXnau3AiGGc_2g5-SWGpW3zrvtcFQDRjRMtlRsK0nVZ1BMAiYW/s1600/One-Flew-Over-the-Cuckoos-001.jpg" height="120" width="200" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;"><span style="font-size: xx-small;">The cuckoo's nests have closed. What <br />else has changed in mental health?</span></td></tr>
</tbody></table>
<div class="Body">
<span lang="EN-US"><span style="font-family: Georgia, Times New Roman, serif;">The theme
of this year’s <a href="http://www.mentalhealth.org.uk/our-work/world-mental-health-day/world-mental-health-day-2014/">World
Mental Health Day</a> on 10th October is <i>Living
with Schizophrenia</i>. For those of us of a certain age, and with a historical
bent, it’s also an opportunity to compare services now with those provided when we started out in
the 1960s. Recently we’ve had the privilege of editing the diaries and
letters of a young man, David, a patient in the mental health system five
decades ago. The resulting <a href="http://www.richardhallam.co.uk/davids-box.html">book</a> offers, we think,
a window into the social attitudes of the time and the way mental health
problems were treated.</span></span></div>
<a name='more'></a><span style="font-family: Georgia, Times New Roman, serif;"> <o:p></o:p></span><br />
<div class="Body">
<span lang="EN-US"><span style="font-family: Georgia, Times New Roman, serif;"> </span></span><span style="font-family: Georgia, 'Times New Roman', serif;">David progressed
in 1958 from child guidance clinic, to adolescent unit, to revolving door
hospital admissions (five as an inpatient and two as a day patient), and three
failed attempts at rehabilitation. He spent nearly six years as an inpatient
although he was never placed in a long-stay hospital. Fortunately, he did not
receive </span><a href="http://psychologydictionary.org/narcotherapy/" style="font-family: Georgia, 'Times New Roman', serif;">narcotherapy</a><span style="font-family: Georgia, 'Times New Roman', serif;">,
</span><a href="http://en.wikipedia.org/wiki/Insulin_shock_therapy" style="font-family: Georgia, 'Times New Roman', serif;">insulin coma
therapy</a><span style="font-family: Georgia, 'Times New Roman', serif;">, or a </span><a href="http://www.thefreedictionary.com/leucotomy" style="font-family: Georgia, 'Times New Roman', serif;">leucotomy</a><span style="font-family: Georgia, 'Times New Roman', serif;">,
like some of his fellow patients. He eventually opted for </span><a href="http://en.wikipedia.org/wiki/Electroconvulsive_therapy" style="font-family: Georgia, 'Times New Roman', serif;">ECT</a><span style="font-family: Georgia, 'Times New Roman', serif;">, perhaps
a difficult choice, but the offer was then withdrawn. When he committed suicide
at the age of 27, he was working and living independently, and in a rational
frame of mind. Something that hasn’t changed is the </span><a href="http://www.annals-general-psychiatry.com/content/6/1/10" style="font-family: Georgia, 'Times New Roman', serif;">high rate of
suicide</a><span style="font-family: Georgia, 'Times New Roman', serif;"> among people with a label of schizophrenia.</span></div>
<div class="Body">
<br /></div>
<div class="Body">
<span lang="EN-US"><span style="font-family: Georgia, Times New Roman, serif;">The NHS in
the 1960s was a service without geographical barriers. David received help
wherever he happened to be living or was sent. Nowadays, moving home across the
street could mean transferring to a new set of workers in a different CMHT. We
know of one young man, recently readmitted to hospital during a psychotic
episode, who was told to go back home by bus to fetch his medication (which he
was quite incapable of doing). Medication had to be paid for by his GP, not the
hospital! <o:p></o:p></span></span></div>
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<span lang="EN-US"><span style="font-family: Georgia, Times New Roman, serif;">Financial
accounting in the 1960s followed a corner shop mentality. David was paid by the
hour for work he carried out at OT, but when he worked outside the hospital, he
had to return a large proportion of his earnings for his upkeep. The message he
continually received was ‘get back to work’ and some of his psychiatrists
adopted the attitude that he was both mad and lazy. Attempts at industrial
rehabilitation in simulated real-life conditions always failed, and there
appeared to be no assessment of his psychological needs. In fact, there was an
absence of any psychological intervention apart from cognitive assessment. <o:p></o:p></span></span></div>
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<div class="MsoNormal">
<span lang="EN-US"><span style="font-family: Georgia, Times New Roman, serif;">In
the early 1960s, nurses were forbidden access to his case notes and they had no
designated therapeutic role. We interviewed a man who had nursed David and
remembered him well. Apparently, nurses became close to patients through daily
contact, but speaking to relatives about family matters would have been seen as
treading on medical authority. This proscription seems particularly absurd
given that we could find no evidence that David ever received any counselling
and interviews with doctors were solely concerned with privileges and
medication. <o:p></o:p></span></span></div>
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<span lang="EN-US"><span style="font-family: Georgia, Times New Roman, serif;">Psychiatric
textbooks of the period painted schizophrenia as an incurable progressive
deterioration of the personality. Medication was given to merely ameliorate its
effects. David received almost every new drug as it appeared on the market,
becoming seriously addicted to <a href="http://en.wikipedia.org/wiki/Methaqualone">Mandrax</a>. He firmly
believed that medication was destroying his memory and intelligence, and there
are <a href="http://news.bbc.co.uk/1/hi/health/8138893.stm">some who would
argue</a> that he may not have been far off the mark. One reason for writing
his diaries was to have a record of what happened to him.<o:p></o:p></span></span></div>
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<br /></div>
<div class="MsoNormal">
<span lang="EN-US"><span style="font-family: Georgia, Times New Roman, serif;">With
respect to viewing schizophrenia as amenable to therapy, there has been a
profound revision of the dogma of intractability and inevitable decline. These days
there may be greater optimism about new approaches to therapy. However, whether
there is a <a href="http://discursiveoftunbridgewells.blogspot.co.uk/2014/04/a-national-scandal-psychological.html">sufficient
number</a> of skilled professionals and other resources to make this presently
available is a different matter. As in the 1960s, the first line of treatment
is still medication. <o:p></o:p></span></span></div>
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<span lang="EN-US"><span style="font-family: Georgia, Times New Roman, serif;"><br /></span></span></div>
<div class="MsoNormal">
<span lang="EN-US"><span style="font-family: Georgia, Times New Roman, serif;">According
to <a href="http://www.rethink.org/news-views/2013/11/attitudes-to-mental-illness">surveys</a>
the stigma of ‘severe mental illness’ has changed little. David’s family always
regarded him as rational, if occasionally a bit ‘potty’ or ‘bonkers.’ David’s
preferred terms of abuse, applied as much to himself as to his doctors,
included ‘psychotic’, ‘paranoid’ and ‘neurotic.’ Illustrating the stigma
attaching to these labels, when David attempted to explain to a potential
employer that he had only ‘mild schizophrenia’, this was met with fury by his
Mental Welfare Officer who said that he had deliberately sabotaged his chances.
Shortly before his suicide, David talked of being tormented by local youths,
and he was dismayed to discover at work that everyone knew he was living in a
half-way house in the grounds of a mental hospital. <o:p></o:p></span></span></div>
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<br /></div>
<div class="MsoNormal">
<span lang="EN-US"><span style="font-family: Georgia, Times New Roman, serif;">So
what has happened to the system of David’s time? The closure of the large
mental hospitals and the introduction of community care is the most obvious
change. Some of the hospitals he attended remain open. One is now a housing
estate. Of two rehabilitation settings, one is a private school, the other a
Management Training Centre. Hospital beds have been reduced from around 150,000
in the 1950s to around 20,000 today, leading one to doubt that there is a
sufficient number for temporary refuge. <o:p></o:p></span></span></div>
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<br /></div>
<div class="MsoNormal">
<span lang="EN-US"><span style="font-family: Georgia, Times New Roman, serif;">Acute
wards in David’s hospital contained people with a toxic mix of problems, as
happens now, although it is unlikely that present day wards would include the
dementing elderly and youths convicted of GBH. On the non-acute wards he was
able to enjoy a leisurely, if rather pointless, existence of evenings in the
pub, cricket, reading library books, dances at OT, and conversations with
nurses and fellow patients about current affairs. To live independently today,
in loosely supervised accommodation where residents do not talk to each other,
is probably far more demoralising. Real involvement in the community was rare. David
eventually achieved something in this respect but at the cost of great stress
to himself. There are now ‘survivor’ movements that offer alternative identities
and a political voice and this represents one of the most profound shifts
since David’s time.<o:p></o:p></span></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span style="font-family: Georgia, Times New Roman, serif;"><span lang="EN-US">Perhaps
of most concern though are the present cuts to mental health budgets and
welfare benefits. There are more than a few echos of 1960s in the emphasis on
paid work and the view that self-management as the solution to everything. In this respect it's unfortunately a case of p</span><span lang="EN">lus ça change</span><span lang="EN-US"> Mr Duncan-Smith.<o:p></o:p></span></span></div>
<div class="MsoNormal">
<br /></div>
<br />
<div class="MsoNormal">
<span style="font-family: Georgia, Times New Roman, serif;"><i><span lang="EN-US">David’s Box</span></i><span lang="EN-US"> is now
available as an ebook from <a href="http://www.troubador.co.uk/"><span style="color: #000099;">www.troubador.co.uk</span></a> at £5.99 and via <a href="http://www.amazon.co.uk/Davids-Box-Diagnosed-Schizophrenic-1960-1971/dp/0956097510">Amazon</a>.</span></span><span lang="EN" style="font-family: Arial, sans-serif; font-size: 11pt;"><o:p></o:p></span></div>
CCCU Applied Psychologyhttp://www.blogger.com/profile/12127528347937708211noreply@blogger.com2tag:blogger.com,1999:blog-3737633890176949647.post-23736843638462244222014-05-30T15:32:00.001+01:002014-05-30T15:32:39.729+01:00Against Mindfulness<div class="Normal1">
<i><a href="http://discursiveoftunbridgewells.blogspot.co.uk/search/label/Huw%20Green%20%28Author%29">Huw Green</a></i></div>
<div class="Normal1">
<br /></div>
<table cellpadding="0" cellspacing="0" class="tr-caption-container" style="float: left; margin-right: 1em; text-align: left;"><tbody>
<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjrScL4EOuyD17vCZX1rz3N42Dsbvt9ew7mKnv5msO2Xq7GcOHBZBLypBMA6swyAUhMpxafRUj6RbxyC-LhLNWyMcyFMgU0wXuXWzXHvoPO15EAI8QIFa0T1G8d-3gwDgSIJVnk8mLzK7bb/s1600/meditation.jpg" imageanchor="1" style="clear: left; margin-bottom: 1em; margin-left: auto; margin-right: auto;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjrScL4EOuyD17vCZX1rz3N42Dsbvt9ew7mKnv5msO2Xq7GcOHBZBLypBMA6swyAUhMpxafRUj6RbxyC-LhLNWyMcyFMgU0wXuXWzXHvoPO15EAI8QIFa0T1G8d-3gwDgSIJVnk8mLzK7bb/s1600/meditation.jpg" height="150" width="200" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;"><span style="font-size: xx-small;">Eat, pray, love and proselytise?</span></td></tr>
</tbody></table>
<div class="Normal1">
<span lang="EN-US">Mindfulness, it gets everywhere. From mental
health services, to schools and into the House of Commons <a href="http://www.telegraph.co.uk/health/wellbeing/10694775/Why-does-the-Government-want-to-teach-mindfulness-in-schools.html"><span style="color: windowtext; text-decoration: none; text-underline: none;"> </span></a><a href="http://www.telegraph.co.uk/health/wellbeing/10694775/Why-does-the-Government-want-to-teach-mindfulness-in-schools.html"><span style="color: #1155cc;">pupils</span></a>,<a href="http://www.huffingtonpost.com/2014/05/16/matt-tenney-mindfulness_n_5340041.html"><span style="color: windowtext; text-decoration: none; text-underline: none;"> </span></a><a href="http://www.huffingtonpost.com/2014/05/16/matt-tenney-mindfulness_n_5340041.html"><span style="color: #1155cc;">prisoners</span></a><u><span style="color: #1155cc;"> </span></u>and<a href="http://www.theguardian.com/society/2014/may/07/politicians-ruby-wax-parliament-mindfulness-meditation"><span style="color: windowtext; text-decoration: none; text-underline: none;"> </span></a><a href="http://www.theguardian.com/society/2014/may/07/politicians-ruby-wax-parliament-mindfulness-meditation"><span style="color: #1155cc;">politicians</span></a><u><span style="color: #1155cc;"> </span></u>are
taking a breath, holding that thought and just...<i>noticing</i>. It begins to feel like Woody Allen’s vision of 1970s New
York, where everyone is in psychoanalysis. Mindfulness is not just a new form
of treatment, it is a way of life for growing numbers of people.</span></div>
<a name='more'></a><o:p></o:p><br />
<div class="Normal1">
<span lang="EN-US"> </span>I must confess to some desire to provoke in
choosing the title for this post. I am no more ‘against’ mindfulness than I am
against psychotherapy, formulation or exercise. Mindfulness evidently has a
place in the spiritual lives of many, and in mental health services, as a form
of anxiety reduction, as a way to get people in touch with their inner world,
as a way to manage the agony that some people feel in simply being alive.
However, what I <i>am </i>against is a
certain breed of unbridled enthusiasm that can make innovations like
Mindfulness seem like they are not only magically transformative but also<a href="http://www.theguardian.com/commentisfree/2014/may/06/mindfulness-hospitals-schools"><span style="color: windowtext; text-decoration: none; text-underline: none;"> </span></a><a href="http://www.theguardian.com/commentisfree/2014/may/06/mindfulness-hospitals-schools"><span style="color: #1155cc;">mandatory</span></a>. Despite the reserve of its
promoters (on full and worthy display in the excellent Guardian article<a href="http://www.theguardian.com/society/2014/feb/23/should-we-be-mindful-of-mindfulness-nhs-depression"><span style="color: windowtext; text-decoration: none; text-underline: none;"> </span></a><a href="http://www.theguardian.com/society/2014/feb/23/should-we-be-mindful-of-mindfulness-nhs-depression"><span style="color: #1155cc;">here</span></a>) the way Mindfulness is spoken about,
written about and thought about suggests caution has been thrown increasingly
to the wind.</div>
<div class="Normal1">
<br /></div>
<div class="Normal1">
<span lang="EN-US">Psychotherapeutic innovations, much like
medical innovations, travel on a wing and a prayer. We try something out for X
and find it helpful, so it makes good sense to consider applying it to Y. It is
no wonder that Mindfulness has moved from being a way to manage<a href="http://www.randomhouse.com/book/89149/full-catastrophe-living-revised-edition-by-jon-kabat-zinn"><span style="color: windowtext; text-decoration: none; text-underline: none;"> </span></a><a href="http://www.randomhouse.com/book/89149/full-catastrophe-living-revised-edition-by-jon-kabat-zinn"><span style="color: #1155cc;">stress and illness</span></a>, to being a component of<a href="http://en.wikipedia.org/wiki/Dialectical_behavior_therapy"><span style="color: windowtext; text-decoration: none; text-underline: none;"> </span></a><a href="http://en.wikipedia.org/wiki/Dialectical_behavior_therapy"><span style="color: #1155cc;">major treatment</span></a> for borderline personality to
being a<a href="http://www.barnesandnoble.com/w/the-mindful-way-through-depression-mark-g-williams/1116762895?ean=9781593851286&isbn=9781593851286"><span style="color: windowtext; text-decoration: none; text-underline: none;"> </span></a><a href="http://www.barnesandnoble.com/w/the-mindful-way-through-depression-mark-g-williams/1116762895?ean=9781593851286&isbn=9781593851286"><span style="color: #1155cc;">depression</span></a> intervention and way beyond.<o:p></o:p></span></div>
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<br /></div>
<div class="Normal1">
<span lang="EN-US">There is talk of a move toward the use of
Mindfulness in the<a href="http://journals.cambridge.org/action/displayAbstract?fromPage=online&aid=318019"><span style="color: windowtext; text-decoration: none; text-underline: none;"> </span></a><a href="http://journals.cambridge.org/action/displayAbstract?fromPage=online&aid=318019"><span style="color: #1155cc;">treatment of psychosis</span></a>. When Peter Liddle and
his colleagues found an association between psychosis and a disruption to the
insula-frontal loop that regulates salience,<a href="http://www.eurekalert.org/pub_releases/2013-08/uon-ssl082013.php"><span style="color: windowtext; text-decoration: none; text-underline: none;"> </span></a><a href="http://www.eurekalert.org/pub_releases/2013-08/uon-ssl082013.php"><span style="color: #1155cc;">it was suggested</span></a> Mindfulness might play a role
in boosting insula function if practiced hard enough to increase the density of
the brain. It’s early days yet, and one can easily imagine that the capacity to
differentiate different internal states could be very beneficial for people in
whom this capacity gets disrupted. However, given that psychosis has long been
theorised as a breakdown in the basic integrity of the sense of self (see<a href="http://schizophreniabulletin.oxfordjournals.org/content/29/3/427.full.pdf"><span style="color: windowtext; text-decoration: none; text-underline: none;"> </span></a><a href="http://schizophreniabulletin.oxfordjournals.org/content/29/3/427.full.pdf"><span style="color: #1155cc;">here</span></a><u><span style="color: #1155cc;"> </span></u>for
a phenomenological account and <a href="http://www.sciencedirect.com/science/article/pii/S1053810005000607"><span style="color: #1155cc;">here </span></a>one focused more on cognitive
neuroscience), the deployment of an intervention that promotes further flight
from the ego seems to me to be a step we should be taking very<a href="http://anp.sagepub.com/content/early/2013/11/11/0004867413512688.extract"><span style="color: windowtext; text-decoration: none; text-underline: none;"> </span></a><a href="http://anp.sagepub.com/content/early/2013/11/11/0004867413512688.extract"><span style="color: #1155cc;">cautiously indeed</span></a>.<o:p></o:p></span></div>
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<br /></div>
<div class="Normal1">
<span lang="EN-US">Awareness of one’s existential states is not
unique to Mindfulness, it has a rich tradition in psychoanalytic and
phenomenological psychology and is a wonderful autonomy granting thing. The
integrative psychotherapist Paul Wachtel has suggested that, in terms of
self-observation, there is a huge overlap between the internal mental focus of
psychoanalysis and the focused breathing activities of behavioural anxiety
reduction. So why has this Buddhist variant been such a smashing success
recently? A sceptic might suggest an element of faddism, and I would humbly
submit they could be onto something. This is not to say there is anything
faddish about regular meditative practice, it’s strenuous and disciplined, for
at least <i>some </i>proportion of the
people who undertake it.<o:p></o:p></span></div>
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<br /></div>
<div class="Normal1">
<span lang="EN-US">Mindfulness appears superficially to sit
quite well with a holistic and political approach to mental health, but it also
promotes a degree of distance from emotion. This distance can be invaluable,
but there are emotions, even quite unpleasant ones, whose force it can be worth
retaining. Emotions are our lifeblood, the fuel for our internal moral engines.
‘What’s that you say, you’ve furious because you live in a structurally unfair
society?.....And <i>breathe</i>.’<o:p></o:p></span></div>
<div class="Normal1">
<br /></div>
<div class="Normal1">
<span lang="EN-US">This is all somewhat facetious; the obvious
reply is that if Mindfulness detaches you from your emotions then it is not to
nearly the same extent as psychoactive medications. Quite right; my point is
that if one part of mental health care is helping us get some distance from our
emotions, another part is helping us get back in touch with them. This point
has been made in the field of politics, where it is argued (most often by<a href="http://www.huffingtonpost.com/ethan-nichtern/radical-buddhism_b_671972.html"><span style="color: windowtext; text-decoration: none; text-underline: none;"> </span></a><a href="http://www.huffingtonpost.com/ethan-nichtern/radical-buddhism_b_671972.html"><span style="color: #1155cc;">revolutionary Marxists</span></a>, it has to be said)
that cultivating a radical acceptance could also induce an unhealthy degree of
apathy. In short, acquiring Mindfulness about disabling levels of anger, terror
or regret may be the easy part. If it were all your psychologist had to offer,
you might reasonably feel short changed.<o:p></o:p></span></div>
<div class="Normal1">
<br /></div>
<div class="Normal1">
<span lang="EN-US">Mindfulness, it is often said, is partly
about getting in touch with the fact there is no basic self.<a href="http://www.wired.com/2012/05/the-self-illusion-an-interview-with-bruce-hood/"><span style="color: windowtext; text-decoration: none; text-underline: none;"> </span></a><a href="http://www.wired.com/2012/05/the-self-illusion-an-interview-with-bruce-hood/"><span style="color: #1155cc;">Some cognitive scientists feel similarly</span></a>, but
barring any sudden metaphysical breakthroughs, we can safely say that the issue
is moot. Personally I rather like having a self, and for the time being my
university, my family and the taxman all seem to agree it exists (try arguing
it wasn’t you that spent all that money on cake last month). There is something
like a Huw there, I may as well get to know him.<o:p></o:p></span></div>
<div class="Normal1">
<br /></div>
<div class="Normal1">
<span lang="EN-US">My own relationship with Mindfulness is of
course coloured by my personal tastes. Inner awareness can also come from
therapy, from conversation and in the form of extended daydreaming and reverie;
the fascination of realising ‘oh that pissed me off, I wonder why?’ and the
tremendous power of not reacting on impulse. I have spent quite a lot of time
in my own head over the course of my life and with that has come a distance
from immediate reactions, which has often served me well. We should strive to
maintain the deepest respect for people’s relationships with their minds,
however religious, secular or simply idiosyncratic they may be. The question
for the psychologist is how to engage with different approaches to life without
ever becoming proselytisers. <o:p></o:p></span></div>
<div class="Normal1">
<br /></div>
<br />
<div class="Normal1">
<span lang="EN-US">Mindfulness arises out of an ancient
theological system far more complex than can possibly be credited in the
numerous books that now fill the self help sections. The current western
fashion does something rather tawdry to this historical legacy, seeming to don
it as easily as a cheap pashmina. I have no principled stance against the
secular appropriation of religious activities (I celebrate a fairly Godless
Christmas), but many of the now widespread uses of Mindfulness, and of Buddhism
in general, leave me cold. <o:p></o:p></span></div>
CCCU Applied Psychologyhttp://www.blogger.com/profile/12127528347937708211noreply@blogger.com6tag:blogger.com,1999:blog-3737633890176949647.post-91020142555593307032014-05-22T13:14:00.002+01:002014-05-22T13:14:52.557+01:0020 years on: Finally our myopic brain obsession is on the wane <div class="MsoNormal">
<i>Professor</i> <b><i>John
Read</i></b><i>, back in the UK after a long
period away, is struck by some important changes in the way we view mental health
problems</i></div>
<div class="MsoNormal">
<i><br /></i></div>
<table cellpadding="0" cellspacing="0" class="tr-caption-container" style="float: left; margin-right: 1em; text-align: left;"><tbody>
<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjvss_bT_pIR_vcENO4_ioKNZ0dmXdCFtYUMBZ9KRc4KCUUNRWNbDlyEUPKzjg1u7xsU5tbcshY0ZEUTTe3tukQn-FZGrT2jXkYgCwG5NOJjV52iBBl94lHc5Fp1nnsEXn9Kv_3QujMs7mB/s1600/mental-illness.jpg" imageanchor="1" style="clear: left; margin-bottom: 1em; margin-left: auto; margin-right: auto;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjvss_bT_pIR_vcENO4_ioKNZ0dmXdCFtYUMBZ9KRc4KCUUNRWNbDlyEUPKzjg1u7xsU5tbcshY0ZEUTTe3tukQn-FZGrT2jXkYgCwG5NOJjV52iBBl94lHc5Fp1nnsEXn9Kv_3QujMs7mB/s1600/mental-illness.jpg" height="130" width="200" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;"><span style="font-size: xx-small;">Has how we talk about mental health changed?<br />Illustration: Mend the Mind</span></td></tr>
</tbody></table>
<div class="MsoNormal">
It’s good to be back in the UK after twenty years in New
Zealand – well, apart from the weather, the political, economic and spiritual
state of England, and the endless phone calls to India to get someone from up
the road to install a phone. Amid it all I’m writing my first ever blog! What
an antiquated old prof.<o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
As regards mental health research, the difference I notice
most is how far people’s thinking has moved on from the old, simplistic, ‘blame-the-brain-for-
everything-and-medicate’ idea. </div>
<a name='more'></a> <o:p></o:p><br />
<div class="MsoNormal">
Two papers I’ve published since returning will both, I hope,
contribute to this on-going development.
The first was published with colleagues
from Scandinavia and the USA in the journal <i>Neuropsychiatry</i>
With the snappy title ‘<a href="http://www.futuremedicine.com/doi/full/10.2217/npy.13.89"><i>The Traumagenic Neurodevelopmental Model of
Psychosis Revisited’</i></a><i> </i>it reports on 125 papers that support a <a href="http://www.healing-arts.org/tir/perry_contribution_of_early_traumatic_events_to_schizophrenia.pdf">model</a>
we first put forward in 2001 outlining
how psychosis can be related to trauma. This
model is a challenge to those I call ‘contextless brain researchers’: people
who when they find a difference in the brains of two groups of people, assume
that they have found the <i>cause</i> of the
difference. It rarely seems to occur to
them to ask a vital (and some might say obvious) question: ‘what might have <i>happened</i> to make the groups different?’ I
would not for a moment dispute that such researchers are well-intentioned folk.
They may have a deep knowledge of neurology and access to some very fancy technology.
However, they often don’t seem to grasp the simple fact that a primary function
of the brain is to respond to the environment.</div>
<div class="MsoNormal">
<o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
One of the findings underpinning our model is that there are
some striking similarities between the brains of traumatised young children and
those of people diagnosed with schizophrenia. Perhaps the most important is in
the way that the nervous systems (the ‘<a href="http://en.wikipedia.org/wiki/Hypothalamic%E2%80%93pituitary%E2%80%93adrenal_axis">HPA
axis</a>’, to be precise) of the two groups respond to stress. We’ve been told
for decades that the reason that people who experience ‘psychosis’ are
sensitive to stress is genetic. It now
seems that for many people the cause of such heightened sensitivity may lie elsewhere:
in early trauma. <o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
This goes to the heart of whether the much touted ‘bio-psycho-social
model’ and its alter ego the ‘stress-vulnerability model’ really do what it
says on the tin, and offer a genuine integration of nature and nurture. I argue in my book <a href="http://www.amazon.co.uk/Models-Madness-Psychological-Biological-International/dp/0415579538/ref=sr_1_1?s=books&ie=UTF8&qid=1396204297&sr=1-1&keywords=models+of+madness"><i>Models of Madness</i></a> that these
terms can sometimes disguise what is still fundamentally a biological
explanation of our experiences. We’re
told that stress can play a role, but only in people <span lang="EN-US" style="color: #231f20; mso-ansi-language: EN-US; mso-bidi-font-family: Garamond; mso-fareast-font-family: Garamond;">who<span style="letter-spacing: -.15pt;"> </span>already<span style="letter-spacing: .8pt;"> </span>have<span style="letter-spacing: -.2pt;"> </span>a<span style="letter-spacing: .6pt;"> </span>supposed<span style="letter-spacing: .95pt;"> </span>genetic<span style="letter-spacing: 1.1pt;"> </span>predisposition. Life<span style="letter-spacing: -1.1pt;"> </span>events,
even<span style="letter-spacing: -1.0pt;"> </span></span>serious and traumatic ones<span lang="EN-US" style="color: #231f20; letter-spacing: -1.0pt; mso-ansi-language: EN-US; mso-bidi-font-family: Garamond; mso-fareast-font-family: Garamond;">, are </span><span lang="EN-US" style="color: #231f20; mso-ansi-language: EN-US; mso-bidi-font-family: Garamond; mso-fareast-font-family: Garamond;">relegated<span style="letter-spacing: .5pt;"> </span>to<span style="letter-spacing: -.25pt;"> </span>the<span style="letter-spacing: .1pt;"> </span>role<span style="letter-spacing: -.55pt;"> </span>of<span style="letter-spacing: .5pt;"> </span>‘triggers’
of<span style="letter-spacing: .5pt; mso-font-width: 86%;"> </span>an<span style="letter-spacing: -.2pt;"> </span>underlying
genetic<span style="letter-spacing: .65pt;"> </span>time<span style="letter-spacing: 1.1pt;"> </span>bomb. Bio-genetics enthusiasts claim that
the ‘vulnerability’ part of the equation must be genetic. This conveniently
ignores the fact that the inventors of the model, Joseph Zubin and Bonnie Spring,
stated in their </span><a href="http://psycnet.apa.org/journals/abn/86/2/103/"><span lang="EN-US">seminal 1977 paper</span></a><span lang="EN-US" style="color: #231f20; mso-ansi-language: EN-US; mso-bidi-font-family: Garamond; mso-fareast-font-family: Garamond;"> that the vulnerability can be acquired from
early life events. As Michael Caine used to say, ‘Not a lot of people know that’.<o:p></o:p></span></div>
<div class="MsoNormal">
<span lang="EN-US" style="color: #231f20; mso-ansi-language: EN-US; mso-bidi-font-family: Garamond; mso-fareast-font-family: Garamond;"><br /></span></div>
<div class="MsoNormal">
<span lang="EN-US" style="color: #231f20; mso-ansi-language: EN-US; mso-bidi-font-family: Garamond; mso-fareast-font-family: Garamond;">This all
reminds me that a few years back Robin Murray, Professor of Research at
London’s Institute of Psychiatry, announced from a Canadian conference stage
that ‘The schizophrenia wars ended in the 1970s’. I couldn’t help raising my
hand and pointing out that the occupying force in a colonial war is usually
quick to announce the end of hostilities, and that the war would not be over
until the occupying forces withdrew to the appropriate boundary.<o:p></o:p></span></div>
<div class="MsoNormal">
<span lang="EN-US" style="color: #231f20; mso-ansi-language: EN-US; mso-bidi-font-family: Garamond; mso-fareast-font-family: Garamond;"><br /></span></div>
<div class="MsoNormal">
<span lang="EN-US" style="color: #231f20; mso-ansi-language: EN-US; mso-bidi-font-family: Garamond; mso-fareast-font-family: Garamond;">It is
remarkable then that the relationship between trauma and psychosis – heresy
just 15 years ago - is now one of the strongest and most consistent findings in
our field. How times have changed – and how quickly. I now hear people saying
‘What’s all the fuss about? We always knew that - nothing controversial there’.
Some of the most scathing critics of our first few papers are now happily
putting their names on papers confirming the relationship. I was moaning about the ‘hypocrisy’ of all
this to my colleague Richard Bentall recently and he replied ‘John, John, -
you’ve won and you’re still bitching!’<o:p></o:p></span></div>
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<span lang="EN-US" style="color: #231f20; mso-ansi-language: EN-US; mso-bidi-font-family: Garamond; mso-fareast-font-family: Garamond;"><br /></span></div>
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<span lang="EN-US" style="color: #231f20; mso-ansi-language: EN-US; mso-bidi-font-family: Garamond; mso-fareast-font-family: Garamond;">The
‘victory’ had never felt so real as when I heard some wonderful news from New
Zealand towards the end of last year. An abuse survivor had twice been denied
financial aid in relation to subsequent mental health problems because two ‘experts’
- employed by the agency responsible for making such payments - had stated that
there is no evidence that child abuse can cause psychosis. However, in the
final appeal a psychiatrist summarised the substantial literature which attests
otherwise. The judge </span><a href="http://m.stuff.co.nz/national/health/9490650/ACC-to-rethink-abuse-link"><span lang="EN-US">upheld the appeal</span></a><span lang="EN-US" style="color: #231f20; mso-ansi-language: EN-US; mso-bidi-font-family: Garamond; mso-fareast-font-family: Garamond;"> and
I’ll admit I took some naughty pleasure in the NZ’s national Sunday newspaper quoting
me as saying that the first two psychiatrists, ‘</span><span lang="EN-US">either knew nothing
about the many studies documenting the relationship between child abuse and
psychosis or were trying to mislead the judge’.<o:p></o:p></span></div>
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<span lang="EN-US">Another area where research is challenging the simplistic medical model
type thinking in mental health is that of interventions. More and more studies are giving the lie to
the pharmaceutical company propaganda which would have us believe that their
products are targeted, specific ‘treatments’ for identified brain problems. My </span><a href="http://dx.doi.org/10.1016/j.psychres.2014.01.042"><span lang="EN-US">second recent paper</span></a><span lang="EN-US"> reported an online survey of 1,829 people taking
antidepressants. It revealed some astonishing levels of
psychological and interpersonal adverse effects. For example, 60% of people reported
feeling emotionally numb, 42% said that the drugs reduced positive as well as
negative emotions, and 39% felt that they cared less about others whilst on the
drug. Other effects are already well documented but we were surprised at their
sheer frequency: 62% reported sexual difficulties (rising to 72% for men), and
39% reported feeling suicidal, rising to 55% in 18-25 year olds. Withdrawal effects,
often dismissed as rare or imagined – were reported by 55%. Those who had been
more depressed when the drugs were first prescribed were no more likely than
others to experience these effects, suggesting that they were drug-related
rather than symptoms of the depression itself. <o:p></o:p></span></div>
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<span lang="EN-US">Although biologically-rooted explanations of distress and pharmaceutical
treatments are still prevalent, it seems that both professionals and the public
are increasingly exploring alternatives. All over the world – with the sole
exception of the USA – <a href="http://www.dbdouble.freeuk.com/actastigma.pdf">surveys
reveal</a> that the public, including service users and carers, tends to take
the common-sense view that mental health problems are related much more closely
to the events and circumstances of our lives than to biological factors such as
genetics or brain chemicals. When it comes to help the public also strongly
prefer psychological and social approaches over drugs, electroshock therapy or
hospitals. Only a minority of
professionals seem intent on continuing to ignore experience and push the idea
that mental health problems are essentially problems with our brains. And those
people are getting older by the minute. Things have changed unbelievably in 20
years. Hopefully, if we all keep pushing, in whatever way our circumstances
allow, our mental health services will finally become evidence-based, effective
and humane. <o:p></o:p></span></div>
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<a href="http://www.liv.ac.uk/psychology-health-and-society/staff/case-studies/john-read/"><span lang="EN-US">John Read</span></a><span lang="EN-US"> is
Professor of Clinical Psychology and Director of the Clinical Psychology Programme
at Liverpool University. You can follow him on Twitter </span><span style="font-size: 10.0pt; line-height: 115%;">@ReadReadj</span><span lang="EN-US"><o:p></o:p></span></div>
CCCU Applied Psychologyhttp://www.blogger.com/profile/12127528347937708211noreply@blogger.com12tag:blogger.com,1999:blog-3737633890176949647.post-60749940530095056502014-04-10T13:37:00.002+01:002014-04-10T14:23:55.381+01:00A national scandal: psychological therapies for psychosis are helpful, but unavailable<div class="MsoNormal">
<span style="font-family: Georgia, Times New Roman, serif;"><a href="http://discursiveoftunbridgewells.blogspot.co.uk/search/label/Peter%20Kinderman%20%28Author%29"><i>Peter
Kinderman</i></a><i> and </i><i><a href="http://discursiveoftunbridgewells.blogspot.co.uk/search/label/Anne%20Cooke%20%28Author%29">Anne Cooke</a></i><i><o:p></o:p></i></span></div>
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<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgOhyphenhyphenQxKXTZsZ0VnEkuyk-s1_FrYa5IFfjfCJXm2b_ch4S1lorJm73I27245bnlnZeFuIHPBXcsAqyXi9_NqmRzCkTHr_yKWGDXOz5C39rZhL811u2twlnT-wryGx5qIq2E4ZA5JGYuDByo/s1600/Talking+therapy.jpg" imageanchor="1" style="clear: left; margin-bottom: 1em; margin-left: auto; margin-right: auto;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgOhyphenhyphenQxKXTZsZ0VnEkuyk-s1_FrYa5IFfjfCJXm2b_ch4S1lorJm73I27245bnlnZeFuIHPBXcsAqyXi9_NqmRzCkTHr_yKWGDXOz5C39rZhL811u2twlnT-wryGx5qIq2E4ZA5JGYuDByo/s1600/Talking+therapy.jpg" height="133" width="200" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;"><span style="font-size: xx-small;">Can talking therapies be a realistic response <br />to psychosis and schizophrenia?<br />Photo: minds2mend.com</span></td></tr>
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<span style="font-family: Georgia, Times New Roman, serif;">For years, drugs were it. If you
felt paranoid, heard voices or were diagnosed with schizophrenia, the only
thing likely to be on offer was ‘antipsychotic’ medication. Like all drugs, these have a number of
different effects on our nervous system. Some of the effects can be helpful,
for example calming us down or making our experiences less intense or
distressing. Others may be less desirable. The unwanted
effects – euphemistically called ‘side’ effects – of these particular drugs can
be seriously distressing. For some people,
they can be more disabling than the original problem. Despite the <a href="http://www.amazon.co.uk/The-Bitterest-Pills-Troubling-Antipsychotic/dp/1137277432/ref%3Dsr_1_1?ie=UTF8&qid=1382396081&sr=8-1&keywords=The+Bitterest+Pills">drug industry hype</a>, it’s been a fine balance for many people,
and worrying evidence is now emerging that some drugs can cause <a href="http://www.newscientist.com/article/mg22129551.400-antipsychotic-drugs-are-schizophrenias-hidden-gulag.html#.UzaLuK1_tr4">serious and permanent problems</a> such as <a href="http://joannamoncrieff.com/2013/12/13/antipsychotics-and-brain-shrinkage-an-update/">brain shrinkage</a> if taken long-term.</span></div>
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<span style="font-family: Georgia, Times New Roman, serif;"> In view of the downsides of
antipsychotics it comes as something of a relief that there is a possible
alternative. Psychological approaches
such as cognitive behaviour therapy (or CBTp, the ‘p’ standing for psychosis)
have become increasingly popular. NICE (the National Institute for Care
Excellence) is sufficiently convinced of the effectiveness of these approaches to
recommend that they should be offered to everyone with a diagnosis of
schizophrenia. Traditionally they have
been offered in addition to drugs, but a <a href="http://www.theguardian.com/science/blog/2014/mar/07/treat-schizophrenia-antipsychotics-drugs-cognitive-therapy">recent trial</a> suggests that they might also be promising
as an alternative. </span></div>
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<span style="font-family: Georgia, Times New Roman, serif;">Last week saw a flurry of debate
about this issue. On Wednesday, the Guardian published an <a href="http://www.theguardian.com/science/sifting-the-evidence/2014/apr/02/has-cognitive-behavioural-therapy-for-psychosis-been-oversold">article</a> somewhat sceptical of the value of psychological therapies for people
experiencing psychosis. The same day, a
packed house at London’s famous Institute of Psychiatry <a href="https://www.kcl.ac.uk/iop/news/debates/index.aspx">debated</a> the motion ‘This House Believes that CBT for Psychosis has been Oversold’. We were there: Peter was one of the speakers
against the motion. <o:p></o:p></span></div>
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<span style="font-family: Georgia, Times New Roman, serif;">The proposers of the motion
suggested that CBTp should ‘live or die by meta-analysis’. A meta-analysis, for the uninitiated, is a statistical
technique that allows findings from various trials to be averaged out. As in the Guardian article, the argument was
that some of the claims made by researchers in this field have been overblown. <o:p></o:p></span></div>
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<span style="font-family: Georgia, Times New Roman, serif;">Psychiatrist David Kingdon, himself
a leading researcher in the field and responsible for some of the trials, countered
that only certain studies get selected for meta-analyses. He also gave some of
the background behind the figures – what actually happened, and what the (often
positive and grateful) participants in the studies actually said. The
yardstick for overselling in the mental health field has to be the efforts of
the pharmaceutical industry. Professor Kingdon asked the audience - many of
them NHS clinicians with offices overflowing with drug company freebies – if
they could remember ever seeing a mug or post-it note with ‘Psychological Therapy
for Psychosis’ or ‘CBTp’ printed on it in a fancy typeface? There was slight shuffling while members of
the audience discreetly covered up the drug company pads and pens they were
using…<o:p></o:p></span></div>
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<span style="font-family: Georgia, Times New Roman, serif;">As often happens, all four
debaters were white, male, middle class academics, but we did hear from people
who’d been offered therapy, including this man, David: “<i>CBT has helped me remain aloof from this voice and I no longer believe
what it says. I now think of it as a petty bully and don’t let it bother me….
The only thing I regret is that I didn’t have access to CBT sooner – it could
have prevented a lot of suicide attempts and I wouldn’t have felt so awful for
so long.”</i> <o:p></o:p></span></div>
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<span style="font-family: Georgia, Times New Roman, serif;">The problem with many trials, and
therefore with meta-analyses too, is that professionals decide in advance what
they are going to measure and what counts as a ‘good’ outcome. Those may or may not be the things that are
actually important to people. For
example, trials frequently measure ‘symptom intensity’ – how loud someone’s
voices are, say. That may of course be
irrelevant to how upsetting the person finds them, how satisfied they are with
their life more generally, or what their expectations of therapy are. Even if the intensity of the ‘symptoms’
doesn’t change much, therapy may help with other things, as David’s account
illustrates. <o:p></o:p></span></div>
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<span style="font-family: Georgia, Times New Roman, serif;">We also heard evidence that CBT
can actually lead to changes in the ‘wiring’ of the brain – it’s not just a
sticking plaster solution. And unlike
drugs, talking therapies are only ever offered to people, not foisted or forced
on them. The influential <a href="http://www.schizophreniacommission.org.uk/">Schizophrenia Commission</a> recently
found that despite CBT for psychosis being recommended by NICE, only one in ten
people who could benefit are actually offered it. The other nine presumably get drugs,
willingly or in some cases under duress.<o:p></o:p></span></div>
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<span style="font-family: Georgia, Times New Roman, serif;">Then it was time for the audience
to join in. And they sure did. One
person was concerned that CBT might squeeze out other psychological approaches. A psychiatrist thought that was irrelevant
given how few people are offered any talking therapy – he said that in his
whole career he had never come across <i>anyone</i>
experiencing psychosis who had been offered CBT. Others pointed out that things are moving apace
as we learn what people find helpful, and rather than splitting hairs over the
relative merits of different approaches, we should celebrate that we now have
the science to back up what service users have been telling us for years. When we’re in great distress, be that because
of life events or so-called ‘psychiatric symptoms’ like voices, we need the
opportunity to talk through our experiences and – where relevant - how they
have affected our view of the world. We
need a calm, supportive and non-judgmental atmosphere to do that in, with
someone familiar with the territory. If
that was what mental health services provided, rather than – as too often
happens – just insisting that people accept that they are ‘ill’ and take drugs,
the outlook for those of us who need to use them might be very different.<o:p></o:p></span></div>
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<span style="font-family: Georgia, Times New Roman, serif;">And the result of the
debate? At the show of hands beforehand,
the audience was evenly split (83 for, 87
against, 61 abstainers). After the arguments had been heard, around half of
those who had previously voted for the motion went over to the other side,
together with more than half of the abstainers.
Only 47 voted for the motion and 25 abstained. The vast majority, 132, decided that CBTp has
NOT been oversold. <o:p></o:p></span></div>
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<span style="font-family: Georgia, Times New Roman, serif;">The issue is not one of overselling,
it’s that psychological therapies are shamefully underprovided. <o:p></o:p></span></div>
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<span style="font-family: Georgia, Times New Roman, serif;"><a href="http://www.peterkinderman.com/"><i>Peter Kinderman</i></a><i> is Professor
of Clinical Psychology at the </i><a href="http://www.liv.ac.uk/psychology-health-and-society"><i>University of Liverpool</i></a><i> and author
of ‘A Prescription for Psychiatry’ (due for publication in September 2014).
Follow him on Twitter @peterkinderman. </i><i><span style="color: white;"><o:p></o:p></span></i></span></div>
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<span style="font-family: Georgia, Times New Roman, serif;"><i>Anne Cooke is Joint Clinical Director of the
Doctoral Programme in Clinical Psychology, </i><a href="http://www.canterbury.ac.uk/social-applied-sciences/aspd/"><i>Salomons
Centre for Applied Psychology</i></a></span><i><span style="font-family: Georgia, Times New Roman, serif;">, Canterbury Christ Church University. She is editor of the forthcoming report from
the British Psychological Society Division of Clinical Psychology,
‘Understanding Psychosis and Schizophrenia’. You can follow her on Twitter
@AnneCooke14</span><span style="font-family: Calibri, sans-serif;"><o:p></o:p></span></i></div>
CCCU Applied Psychologyhttp://www.blogger.com/profile/12127528347937708211noreply@blogger.com159tag:blogger.com,1999:blog-3737633890176949647.post-75364169301370207432014-03-07T15:24:00.000+00:002014-03-07T17:05:53.783+00:00Pro-Ana communities: why they draw those starving for sustenance and support<div class="MsoNormal" style="margin-bottom: 0cm;">
<span style="font-family: Georgia, Times New Roman, serif;"><span style="line-height: 27.200000762939453px;"><i>Rosie </i></span><i style="line-height: 27.200000762939453px;">Gilderthorp</i></span><br />
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<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiykymv0d7mdVtM_hNI0igNNsHYMQQgBKaVVnt6lj3Sp99QcWsyPFR8dIF8IwCg7LoDOEaNEDcyGx1tPw-h7WqdtofvT5_vcM7yEEDdRI4ZM9gI8waWOBMpyfA3Ebv2N-Gm2wrsaxNbEdDL/s1600/Carrot.jpg" imageanchor="1" style="clear: left; margin-bottom: 1em; margin-left: auto; margin-right: auto;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiykymv0d7mdVtM_hNI0igNNsHYMQQgBKaVVnt6lj3Sp99QcWsyPFR8dIF8IwCg7LoDOEaNEDcyGx1tPw-h7WqdtofvT5_vcM7yEEDdRI4ZM9gI8waWOBMpyfA3Ebv2N-Gm2wrsaxNbEdDL/s1600/Carrot.jpg" height="194" width="200" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;"><span style="font-size: xx-small;">Pro-ana: Less is more<br />Photo: Gideon Malais</span></td></tr>
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<span style="font-family: Georgia, Times New Roman, serif;"><span style="line-height: 170%;">A colleague recently brought to my
attention a ‘</span><a href="http://en.wikipedia.org/wiki/Pro-ana"><span style="color: blue; line-height: 170%;">pro-ana</span></a><span style="line-height: 170%;">’ thread he had noticed on Twitter.
He was horrified by what he read and I can see why. Twitter exchanges and
message boards like this, consist of young women swapping tips on how to
maintain a dangerously low weight and provide each other with ‘thinspiration’
pictures of sinewy celebrities. Pro-ana networks are a world of women with
glossy hair, gleaming skin and sculpted cheekbones. There are no pictures of
bad skin, thinning hair or infertility (difficult to photograph I accept), and
there are certainly no stories about the </span><a href="http://www.nationaleatingdisorders.org/mortality-and-eating-disorders"><span style="color: blue; line-height: 170%;">death toll of eating disorders</span></a><span style="line-height: 170%;">. I, like my colleague,
initially recoiled from these groups. It’s hard to avoid concluding that they
maintain distorted thinking, fetishise a dangerous aesthetic and uphold
judgments of women based on their weight. I started to think about writing a
blog about shutting them down. However, when my initial horror abated, I began
to wonder why people access them and what needs pro-ana groups seek to fulfil.</span></span></div>
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<span style="font-family: Georgia, Times New Roman, serif;"><o:p></o:p></span><br />
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<span style="line-height: 170%;"><span style="font-family: Georgia, Times New Roman, serif;"> </span></span><span style="font-family: Georgia, 'Times New Roman', serif; line-height: 170%;">The overall message of pro-ana groups
is that young people can support each other by encouraging and celebrating
weight loss while helping to overcome barriers such as hunger and familial
concern. While this makes for uncomfortable reading, I cannot help but notice
that among the negative images there is an undercurrent of validation and hope
for the future. When the administrators of pro-ana groups are challenged,
they invariably respond that they are not promoting anorexia but are helping to
support people who choose to live a ‘low weight lifestyle’. Indeed, it appears
that they are utilising the cornerstones of a therapeutic alliance to do so.
Our initial anxiety about pro-ana groups is not misplaced, but I do feel it is
a complex issue. A point I have seen made several times is that, without access
to the pro-ana network, some individuals might be more at risk. I confess that
I think this argument may have value.</span></div>
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<span style="line-height: 170%;"><span style="font-family: Georgia, Times New Roman, serif;">While those perpetuating the sites
clearly have views I contest about the benefits of a ‘low weight lifestyle’,
they are correct that the young people who access them would be likely to
receive no support at all if they did not use their online profiles to reach
out to others. While I think we have good reason to believe that what these
groups provide is potentially unhelpful, especially given the competitive
element of the condition for some anorexia sufferers, it is apparent that they
fulfil real needs for some, especially those who struggle to access
alternatives.<o:p></o:p></span></span></div>
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<span style="line-height: 170%;"><span style="font-family: Georgia, Times New Roman, serif;">I know that there are support
groups out there, run both by charities and the NHS, for those suffering from
eating disorders. However, mental health professionals are trained to be change
focused. If people are not ready to change we tend to view them as ‘not ready
for therapy’ and, often with heavy hearts, we discharge them. In my short
career I have already had numerous experiences of ending therapy with people
who ‘just aren’t at the point of change yet’. So what is there for these people?
What does society provide for people with eating disorders who are living
exhausted, confused, anxious lives but don’t yet feel strong enough to give up
their perceived sources of emotional support? Well, unfortunately one answer
might be the pro-ana community who, so far as they are concerned, will provide
them with validation without the pre-requisite of change.<o:p></o:p></span></span></div>
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<span style="line-height: 170%;"><span style="font-family: Georgia, Times New Roman, serif;">While we recognise that for many
sufferers eating disorders provide a sense of stability and control, we make no
attempt to provide them with an alternative before asking them to state an
intention of giving this up. There are no assertive outreach teams commissioned
to get alongside these people and provide the support which may eventually
enable them to think about change. So why does someone need to be contemplating
change before we will help them? <o:p></o:p></span></span></div>
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<span style="font-family: Georgia, Times New Roman, serif;"><span style="line-height: 170%;">Perhaps it is our perception of
people with eating disorders which limits our sense of responsibility to help.
These people often appear to live relatively functional lives compared with
others accessing secondary mental health services. We are not often openly
confronted with the risk of death associated with anorexia in our therapy rooms
as few express openly suicidal thoughts. In addition, there is a tendency to
see anorexia as a </span><a href="http://www.dailymail.co.uk/news/article-2257475/Anorexia-disease-middle-classes-says-Springwatch-star-Michaela-Strachan.html"><span style="color: blue; line-height: 170%;">middle class problem</span></a><span style="line-height: 170%;">, a side effect of privilege that
afflicts those without ‘real’ problems as well as teenagers seeking attention
from busy parents. The difference in service provision, when you compare eating
disorders with early intervention for psychosis and drug and alcohol services,
is stark. Perhaps we need to ask ourselves if this is acceptable given the fact
that anorexia has the highest mortality rate of any psychiatric diagnosis and </span><a href="http://www.b-eat.co.uk/about-beat/media-centre/facts-and-figures/"><span style="color: blue; line-height: 170%;">20% of people</span></a><span style="line-height: 170%;"> suffering from it will die
prematurely as a result of their condition.<o:p></o:p></span></span></div>
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<span style="line-height: 170%;"><span style="font-family: Georgia, Times New Roman, serif;">Of course, there would be ethical,
practical and financial hurdles to consider if we were to consider intervening
in a supportive rather than change focused way. However, we overcome those
barriers when we provide assertive outreach for other groups - and, if we are
seriously concerned by pro-ana groups, we surely need to provide a legitimate
alternative. Perhaps this could be a friendly voice at the end of a phone, or
someone who is available for a cup of tea and a chat when the pressures of
living on the point of exhaustion and starvation threaten to overwhelm. Many
people suffering with anorexia clearly recognise that they need support, hence
the popularity of pro-ana communities. Why can’t we provide it in a format that
is not only palatable to them, but manages the risks involved?<o:p></o:p></span></span></div>
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<span style="line-height: 170%;"><span style="font-family: Georgia, Times New Roman, serif;">Perhaps, as well as being critical
of pro-ana groups for what they offer to young people, we should consider what
we provide for this vulnerable group and how the provision of supportive, non
judgmental services could render them obsolete. </span><span style="font-family: Helvetica, sans-serif; font-size: 12pt;"><o:p></o:p></span></span></div>
CCCU Applied Psychologyhttp://www.blogger.com/profile/12127528347937708211noreply@blogger.com2tag:blogger.com,1999:blog-3737633890176949647.post-1835383911354851732014-02-20T09:38:00.000+00:002014-02-20T10:17:14.183+00:00Seduced by biology: The BBC, black dog and biological bias<div class="MsoNormal">
<i><u><span style="color: blue; font-family: ArialMT; font-size: 12.0pt; line-height: 115%; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman";">Sue Holttum</span></u></i><i> suggests that biological explanations for distress may easily
be over-emphasised<o:p></o:p></i></div>
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<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgmkS4Q8IbQ0NdBx2rNtjSENyD2VliVIqAckQXBOann2iEkssWyhLJCQ6eWFhczzJab9Yro8tFA3cx374q30XAv116e2u312DZ6TEuE8KWTu4hDTudUhIwwoYndEY451tOVCeS5YTTsHQiG/s1600/Brain+Helmut+Januschka.jpg" imageanchor="1" style="clear: left; margin-bottom: 1em; margin-left: auto; margin-right: auto;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgmkS4Q8IbQ0NdBx2rNtjSENyD2VliVIqAckQXBOann2iEkssWyhLJCQ6eWFhczzJab9Yro8tFA3cx374q30XAv116e2u312DZ6TEuE8KWTu4hDTudUhIwwoYndEY451tOVCeS5YTTsHQiG/s1600/Brain+Helmut+Januschka.jpg" height="183" width="200" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;"><span style="font-size: xx-small;">Do brains turn our heads?<br />Photo: Helmut Januschka</span></td></tr>
</tbody></table>
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<span style="font-family: ArialMT; font-size: 12pt;">A couple of mornings ago (Tuesday 18th Feb) there was an </span><u><span style="color: blue; font-family: ArialMT; font-size: 12.0pt; mso-bidi-font-family: ArialMT;"><a href="https://audioboo.fm/boos/1930062-predicting-teen-depression-highlights-target-for-treatment"><span style="color: blue;">item</span></a></span></u><span style="font-family: ArialMT; font-size: 12pt;"> on Radio 4’s
Today programme about depression. Specifically, it related to the discovery
that teenage boys with mild (non-clinical) depression, and higher-than-usual
levels of the stress hormone cortisol, were 14 times more likely to develop
clinical depression than other boys of similar age. Presenter, Evan Davis,
interviewed respected neuroscientist, Prof Barbara Sahakian, from Cambridge
University. Instead of asking the obvious question about why these youngsters
are suffering enough stress to raise cortisol levels and be mildly depressed,
Mr Davis asked about possibly correcting cortisol levels and whether cortisol
was the cause of the depression.</span></div>
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<span style="font-family: ArialMT; font-size: 12pt;">On many issues, I respect the BBC’s coverage and feel that it
tries hard to be balanced. However, on this occasion - </span><u><span style="color: blue; font-family: ArialMT; font-size: 12.0pt; mso-bidi-font-family: ArialMT;"><a href="http://bps-research-digest.blogspot.co.uk/2012/01/psychology-ignored-and-depression.html"><span style="color: blue;">as is often the case</span></a></span></u><span style="font-family: ArialMT; font-size: 12pt;"> with reports about mental health - I felt that the balance was
highly questionable. In particular, by focusing on the glamorous technology of
brain/biological science, the BBC was promoting the mistaken idea that distress
is entirely caused by our biology going wrong.</span></div>
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<span style="font-family: ArialMT; font-size: 12pt;">Let’s be clear: depression is not caused by an imbalance of
cortisol. Cortisol is a stress hormone and raised levels of it are our body’s
normal response to stressful events and circumstances. Life events and the
'stuff' that ensues are the cause of cortisol levels rising, and if the ‘stuff’
goes on too long, depression can be the result. <o:p></o:p></span><br />
<span style="font-family: ArialMT; font-size: 12pt;"><br /></span></div>
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<span style="font-family: ArialMT; font-size: 12pt;">There is a mass of evidence to suggest that depression and other
kinds of mental distress are caused by events such as bullying (including via
the internet), neglect, parental over-control and lack of care. For a few
examples, see </span><u><span style="color: blue; font-family: ArialMT; font-size: 12.0pt; mso-bidi-font-family: ArialMT;"><a href="http://psycnet.apa.org/journals/ccp/79/3/353/"><span style="color: blue;">here</span></a></span></u><span style="font-family: ArialMT; font-size: 12pt;">, </span><u><span style="color: blue; font-family: ArialMT; font-size: 12.0pt; mso-bidi-font-family: ArialMT;"><a href="http://www.jad-journal.com/article/S0165-0327(10)00367-8/abstract"><span style="color: blue;">here</span></a></span></u><span style="font-family: ArialMT; font-size: 12pt;">, </span><u><span style="color: blue; font-family: ArialMT; font-size: 12.0pt; mso-bidi-font-family: ArialMT;"><a href="http://bjp.rcpsych.org/content/197/5/378.abstract?sid=5becc30c-27b8-4fae-a7fd-85b237c5fbfa"><span style="color: blue;">here</span></a></span></u><span style="font-family: ArialMT; font-size: 12pt;">, </span><u><span style="color: blue; font-family: ArialMT; font-size: 12.0pt; mso-bidi-font-family: ArialMT;"><a href="http://bjp.rcpsych.org/content/200/2/89.full?sid=d837c1c7-415c-46f4-a950-21a21cd24539"><span style="color: blue;">here</span></a></span></u><span style="font-family: ArialMT; font-size: 12pt;"> and </span><u><span style="color: blue; font-family: ArialMT; font-size: 12.0pt; mso-bidi-font-family: ArialMT;"><a href="http://www.jad-journal.com/article/S0165-0327(13)00805-7/abstract"><span style="color: blue;">here</span></a></span></u><span style="font-family: ArialMT; font-size: 12pt;">. These
references constitute just a fraction of the research linking mental health
problems to adverse live events. There are also wider issues such as poverty,
gang culture, lack of mentoring, employment or training opportunities,
loneliness and homelessness; which are all significant. <o:p></o:p></span></div>
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<span style="font-family: ArialMT; font-size: 12pt;">Simply looking to ‘correct’ people’s cortisol levels would leave
the many social causes of depression and unhappiness unexamined and only make
things worse for all of us. The only beneficiaries are likely to be drug
companies who are looking for ever wider markets for their products, as the
psychiatrist Dr Joanna Moncrieff has </span><u><span style="color: blue; font-family: ArialMT; font-size: 12.0pt; mso-bidi-font-family: ArialMT;"><a href="http://www.ucl.ac.uk/slms/people/show.php?personid=11975"><span style="color: blue;">eloquently highlighted</span></a></span></u><span style="font-family: ArialMT; font-size: 12pt;">. Of course a drug can sometimes alleviate the worst of the
emotional pain. But if we only focus on biological explanations and treatments,
other reasons for distress remain unaddressed and more psychological and
societal ways of addressing problems will be underfunded. These things may be
less glamorous. In many ways they simply reflect ordinary human kindness. But
through the over-focus on ‘sexy’ technology, we are in serious danger of
forgetting the importance of ordinary such fellow-feeling, of psychological
therapies, of community and equality.<o:p></o:p></span></div>
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<span style="font-family: ArialMT; font-size: 12pt;">This is only one item on one radio show but it happens over and
over again, (an </span><u><span style="color: blue; font-family: ArialMT; font-size: 12.0pt; mso-bidi-font-family: ArialMT;"><a href="http://www.telegraph.co.uk/health/10644901/Scientists-hail-first-biological-test-for-clinical-depression.html"><span style="color: blue;">article</span></a></span></u><span style="font-family: ArialMT; font-size: 12pt;"> from The Daily
Telegraph from the 17</span><sup><span style="font-family: ArialMT; font-size: 7pt;">th</span></sup><span style="font-family: ArialMT; font-size: 12pt;"> of February reports a similarly biological focus on depression in
children). These stories are indicative of something bigger and more pervasive.
It seems we have a need to believe biological explanations for all sorts of
human problems, perhaps along with the belief that someone will develop a pill
that can eliminate it. It’s worth looking at this </span><u><span style="color: blue; font-family: ArialMT; font-size: 12.0pt; mso-bidi-font-family: ArialMT;"><a href="http://psycnet.apa.org/journals/bul/137/5/800/"><span style="color: blue;">article</span></a></span></u><span style="font-family: ArialMT; font-size: 12pt;"> by Ilan
Dar-Nimrod and Steven J. Heine, about the way we tend to over-value genetic and
explanations for human phenomena. Such explanations may seduce us and squeeze
out other ways of seeing things.<o:p></o:p></span></div>
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<span style="font-family: ArialMT; font-size: 12pt;">We should beware the simplification of these issues, especially
the desire for one-dimensional explanations. They serve someone’s interests,
but not necessarily ours.<o:p></o:p></span></div>
CCCU Applied Psychologyhttp://www.blogger.com/profile/12127528347937708211noreply@blogger.com5tag:blogger.com,1999:blog-3737633890176949647.post-26826515344297128852014-02-14T17:22:00.000+00:002014-02-17T12:45:36.301+00:00Guest post: What will help prevent tragedies like Mid Staffs happening again? Time for a shift in attention.<div class="MsoNormal">
<i><span style="line-height: 115%;"><span style="font-family: Georgia, Times New Roman, serif;">Steve
Onyett</span></span></i></div>
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<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEh4GYlK8NFv9Sduln-_mQ6VLeyRiX1jptB1aI4bmk5v4pLCc2IYOUkIYd7KbKtqhFTgaEkv1nSFlg93t7A30F5BS14Aa-yfwFXrm9yt8c1zPFZaz__dxdRxLSXsC4QmcF-qOECdP1x1GOjP/s1600/Appreciation.jpg" imageanchor="1" style="clear: left; margin-bottom: 1em; margin-left: auto; margin-right: auto;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEh4GYlK8NFv9Sduln-_mQ6VLeyRiX1jptB1aI4bmk5v4pLCc2IYOUkIYd7KbKtqhFTgaEkv1nSFlg93t7A30F5BS14Aa-yfwFXrm9yt8c1zPFZaz__dxdRxLSXsC4QmcF-qOECdP1x1GOjP/s1600/Appreciation.jpg" height="151" width="200" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;"><span style="font-size: xx-small;">Care and appreciation. Simple but more <br />powerful than we realise<br />Pictue: Deviant Art</span></td></tr>
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<span style="font-family: Georgia, Times New Roman, serif;"><span style="line-height: 115%;">It
seems to have become fashionable to criticise the NHS – or in newspaper-speak
to </span><a href="http://www.bbc.co.uk/news/health-25777429"><span style="line-height: 115%;">‘attack’</span></a><span style="line-height: 115%;"> it. Of course scrutiny of public
services is important, but the relentless focus on blame for failures worries
me. In the </span><a href="http://news24s.com/tag/health-policy/"><span style="line-height: 115%;">words of Dr Cliff Mann</span></a><span style="line-height: 115%;">, president of the College of
Emergency Medicine, ‘we want to make sure that we don't end up demoralising the
very people that we need to keep our health service going’<i>. </i>This sentiment was echoed in <span style="color: red;">a</span> recent
</span><a href="http://www.theguardian.com/society/2013/dec/31/healthcare-leaders-end-criticism-nhs-letter"><span style="line-height: 115%;">open letter</span></a><span style="line-height: 115%;"> in the Guardian from leaders of ten
NHS organisations. I’m encouraged by campaigns like </span><a href="https://twitter.com/butNHS"><span style="line-height: 115%;">‘Big
Up the NHS’</span></a><span style="line-height: 115%;"> on
Twitter which recognise that, as all parents know, praise and encouragement
generally get you much further than relentless criticism. <o:p></o:p></span></span></div>
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<span style="line-height: 115%;"><span style="font-family: Georgia, Times New Roman, serif;">It’s
worth being absolutely clear, though, about the scale of the culture shift
needed to restore a sense of meaning and vocation among NHS staff. Can this be
achieved? How should we go about it? I’d suggest the solutions are radical but
also surprisingly simple. <o:p></o:p></span></span></div>
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<span style="line-height: 115%;"><span style="font-family: Georgia, Times New Roman, serif;"></span></span></div>
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<span style="font-family: Georgia, Times New Roman, serif;"><span style="line-height: 115%;">Let’s
be clear first about what won’t work. Culture change is not achieved by leaders
standing in front of the workers extolling a new set of values, or extorting
behaviour change with threats. Nor are rewards and incentives the answer
(though people should have access to decent pay and conditions). People are
waking up to the dangers of naïve and insulting approaches to incentivising
moral behaviour. As </span><a href="http://www.systemsthinking.co.uk/step6.asp"><span style="line-height: 115%;">John Seddon</span></a><span style="line-height: 115%;"> observed ‘All the research evidence
shows that incentives get you <i>less work</i> and, more importantly, they
result in people attaching less value to their work’.<o:p></o:p></span></span></div>
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<span style="font-family: Georgia, Times New Roman, serif;"><span style="line-height: 115%;">Instead,
initiatives such as the </span><a href="http://www.goodworkcommission.co.uk/"><span style="line-height: 115%;">Good Work Commission</span></a><span style="line-height: 115%;"> highlight the motivational
importance of meaning and the inherent social value of work. For example, </span><a href="http://knowledge.wharton.upenn.edu/article/barry-schwartzs-practical-wisdom/"><span style="line-height: 115%;">Barry Schwartz</span></a><span style="line-height: 115%;"> tells the story of a hospital
janitor who had the job of cleaning the room of a young man who was in a coma
following a fight. This young boy’s father was keeping a vigil all day every
day, except for the times when he would pop out for a cigarette. On one occasion
the dad was out smoking and didn’t see the janitor clean the room and wash the
floor. In fact he accused him of not cleaning it. Although angry at this injustice,
the janitor cleaned the room again. </span></span><span style="font-family: Georgia, 'Times New Roman', serif; line-height: 115%;">He
did this so that the boy’s father could see him clean it. He had some understanding
of what the father was enduring and wanted to do something that the father
could think of as a direct contribution to the welfare of his son.</span></div>
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<span style="font-family: Georgia, Times New Roman, serif;"><span style="line-height: 115%;">Schwartz
observed that this janitor and all the other invisible people who show daily
compassion, could do this because they weren’t being over supervised, and ‘still
[had] time to do what they thought was their real job, which was to provide
comfort and care to patients and their families’. This is skilled and
satisfying work. As Schwartz noted, ‘Over time, you learn when to intervene,
how to intervene and [what] small things you can do that make a big difference’.</span><span style="font-size: 11px; line-height: 12.777777671813965px;">[1]</span><o:p></o:p></span></div>
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<span style="font-family: Georgia, Times New Roman, serif;"><sup><sup><br /></sup></sup></span></div>
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<span style="font-family: Georgia, Times New Roman, serif;"><span style="line-height: 115%;">The</span><span style="line-height: 115%;">
</span><a href="https://www.gov.uk/government/organisations/department-of-health"><span style="line-height: 115%;">Government
Response to the Mid Staffs Inquiry</span></a><span style="line-height: 115%;"> suggests addressing morale
through adequate staffing. This will help. </span><span style="line-height: 115%;">Imagine that same janitor closely monitored, and
over-supervised in pursuit of an unrealistic target (such as the number of
contacts our community care staff have to achieve, particularly overstretched </span><a href="http://www.theguardian.com/society/2013/oct/17/care-review-15-minute-visits"><span style="line-height: 115%;">local authority contracts</span></a><span style="line-height: 115%;">). <o:p></o:p></span></span></div>
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<span style="font-family: Georgia, Times New Roman, serif;"><span style="line-height: 115%;"><br /></span></span></div>
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<span style="line-height: 115%;"><span style="font-family: Georgia, Times New Roman, serif;">However, I worry about some of the other
recommendations of the report: in particular the emphasis on increased scrutiny
through performance management and swift punishment when things go wrong. Of
course, we need to be alert to failures in care, and punishment may play well
for politicians. They might even think this is ‘leadership’. But psychology
teaches us that if we want to change the culture, we need to make our main
focus something else: celebrating the good wherever we find it. The things we
focus on tend to get bigger[2]. <o:p></o:p></span></span></div>
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<span style="line-height: 115%;"><span style="font-family: Georgia, Times New Roman, serif;">Effective
and sustainable cultural change is both personal and simple. It involves us all
shifting our attention further towards the positive in each other and in the actions
we take. As Tony Suchman observed, ‘We are creating the organisation anew in
each moment by what we are saying about it, and how we are relating to each
other as we carry out its work’<span class="MsoEndnoteReference"><!--[if !supportFootnotes]--><span class="MsoEndnoteReference"><span style="line-height: 115%;">[3]</span></span><!--[endif]--></span>.
<o:p></o:p></span></span></div>
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<span style="line-height: 115%;"><span style="font-family: Georgia, Times New Roman, serif;">There
is an opportunity here. It is no surprise that our immediate line managers are
the biggest source of influence on our wellbeing and performance at work<span class="MsoEndnoteReference"><!--[if !supportFootnotes]--><span class="MsoEndnoteReference"><span style="line-height: 115%;">[4]</span></span><!--[endif]--></span>.
This opens up a huge opportunity to do something powerful and extremely
scalable. Research on NHS leadership has found that simply showing authentic
personal concern for someone you are managing probably has more impact than
anything else you might do<span class="MsoEndnoteReference"><!--[if !supportFootnotes]--><span class="MsoEndnoteReference"><span style="line-height: 115%;">[5]</span></span><!--[endif]--></span>.
In a similar vein, the ratio of positive to negative comments within teams has
been found to be four times more powerful than any other factor in creating
effective team performance<span class="MsoEndnoteReference"><!--[if !supportFootnotes]--><span class="MsoEndnoteReference"><span style="line-height: 115%;">[6]</span></span><!--[endif]--></span>.
Clearly, offering care and appreciation to staff is not simply a nice thing to
do. It is the most powerful organisational intervention that any leader or
manager can make. <o:p></o:p></span></span></div>
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<span style="font-family: Georgia, Times New Roman, serif;"><span style="line-height: 115%;">So
how can we relate that to recent NHS failures? Much of the criticism of the NHS
in 2013 was sparked by the lamentable lack of compassion encountered by
patients in Mid Staffordshire. It’s worth thinking a little about what compassion
actually means. </span><a href="http://www.frameworks4change.co.uk/"><span style="line-height: 115%;">Andy Bradley</span></a><span style="line-height: 115%;"> describes compassion as <i>‘where kindness meets suffering and we are
encouraged to flourish’.</i> We flourish when our own suffering is met by
kindness. In other words we are able to offer compassion when we experience
compassion ourselves. This has been recognised by spiritual traditions for a very
long time and is as true for NHS staff as anyone else. In the oldest Theravāda Buddhist
tradition the cultivation of loving-kindness (or Mettā) begins with the self. <o:p></o:p></span></span></div>
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<span style="line-height: 115%;"><span style="font-family: Georgia, Times New Roman, serif;">If
we imprison someone’s natural inclination to express their vocation through
doing good as a commodity to be represented as an activity target or an annual
performance measure, we risk smothering the love they bring to their work. When
this happens we should not be surprised if people express<span style="color: red;">ing </span>loving-kindness for themselves by taking their
love elsewhere – literally, by leaving the NHS, or more subtly and perniciously,
through closing down and becoming exhausted and inert. <o:p></o:p></span></span></div>
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<span style="font-family: Georgia, Times New Roman, serif;"><span style="line-height: 115%;">Peter
Gilbert was an influential writer on public sector leadership who sadly died in
December 2013. </span><a href="http://www.theguardian.com/society/2013/dec/18/peter-gilbert"><span style="line-height: 115%;">His obituary</span></a><span style="line-height: 115%;"> cited his belief that we all have a
spiritual side that needs recognition and expression. In Peter’s words this is <i>‘something about the transcendent; something
beyond ourselves that keeps us going’.</i> For some of us it is a sense of
radical connection with everything around us that we might call ‘love’. Others
might call it ‘God’. Whatever we call it we need a </span><a href="http://www.onyett.org/2013/07/21/the-nature-of-compassionate-leadership/"><span style="line-height: 115%;">compassionate approach to leadership</span></a><span style="line-height: 115%;"> that includes </span><a href="http://www.hostleadership.com/"><span style="line-height: 115%;">hosting
spaces</span></a><span class="MsoEndnoteReference"><span style="line-height: 115%;"><!--[if !supportFootnotes]--><span class="MsoEndnoteReference"><span style="line-height: 115%;">[7]</span></span><!--[endif]--></span></span><span style="line-height: 115%;"> in our hard pressed public services
for staff to maintain their connection to this aspect of themselves – and give
it expression. This requires that they are free to do the right thing with the resources
to be effective. Secondly, they should gain praise and recognition for the good
hearts that drew them to this supremely important and meaningful work in the
first place.</span> <o:p></o:p></span></div>
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<span style="font-family: Georgia, Times New Roman, serif;"><span style="line-height: 115%;"><br /></span></span></div>
<div class="MsoNormal">
<span style="font-family: Georgia, Times New Roman, serif;"><i><span style="line-height: 115%;">Steve Onyett is Associate Professor
in Clinical Psychology at the University of Exeter and Director of </span></i><i><span style="line-height: 115%;"><a href="http://www.onyett.org/">Onyett Entero Ltd</a>. You can follow him on Twitter <a href="https://twitter.com/SteveOnyett">@SteveOnyett</a></span></i></span><br />
<span style="font-family: Georgia, Times New Roman, serif;"><i><br /></i></span>
<span style="font-family: Georgia, Times New Roman, serif;"><i><span style="line-height: 115%;"><br /></span></i></span>
<br />
<div id="edn1">
<div class="MsoEndnoteText">
<span style="font-family: Georgia, Times New Roman, serif; font-size: x-small;"><a href="file:///V:/097%20JOHN%20McGOWAN/Social%20Med/Steve%20Onyett%20-%20How%20to%20prevent%20tragedies%20like%20Mid%20Staffs3.docx#_ednref1" name="_edn1" title=""><span class="MsoEndnoteReference"><span class="MsoEndnoteReference"><span style="color: black; line-height: 14.949999809265137px;">[1]</span></span></span></a> See Schwartz, B. & Sharpe, K. (2010) <i>Practical Wisdom</i>. Riverhead. Similar points about the value of focusing on intrinsic motivation are made by WWF-UK Change Strategist Tom Crompton in this <a href="http://youtu.be/LcD3lS3Utew">talk</a> and in the report <a href="http://assets.wwf.org.uk/downloads/common_cause_report.pdf">‘Common Cause’</a> and in this <a href="http://www.ted.com/talks/dan_pink_on_motivation.html">Daniel Pink TED talk</a>.<span lang="EN-US"><o:p></o:p></span></span></div>
</div>
<div id="edn2">
<div class="MsoEndnoteText">
<span style="font-family: Georgia, Times New Roman, serif; font-size: x-small;"><a href="file:///V:/097%20JOHN%20McGOWAN/Social%20Med/Steve%20Onyett%20-%20How%20to%20prevent%20tragedies%20like%20Mid%20Staffs3.docx#_ednref2" name="_edn2" title=""><span class="MsoEndnoteReference"><span class="MsoEndnoteReference"><span style="color: black; line-height: 14.949999809265137px;">[2]</span></span></span></a> This for example is a central tenet of innovative and effective approaches to organisational change such as <a href="http://appreciativeinquiry.case.edu/">Appreciative Inquiry</a> and work with a <a href="http://www.solworld.org/">Solution Focus</a>.<span lang="EN-US"><o:p></o:p></span></span></div>
</div>
<div id="edn3">
<div class="MsoEndnoteText">
<span style="font-family: Georgia, Times New Roman, serif; font-size: x-small;"><a href="file:///V:/097%20JOHN%20McGOWAN/Social%20Med/Steve%20Onyett%20-%20How%20to%20prevent%20tragedies%20like%20Mid%20Staffs3.docx#_ednref3" name="_edn3" title=""><span class="MsoEndnoteReference"><span class="MsoEndnoteReference"><span style="color: black; line-height: 14.949999809265137px;">[3]</span></span></span></a><span class="MsoEndnoteReference"> </span>Suchman, A. L., Sluyter, D. J., & Williamson, P. R. (2011). <i>Leading Change in Healthcare: Transforming Organisations Using Complexity, Positive Psychology & Relationship-Centered Care</i>. Radcliffe, p.23.<o:p></o:p></span></div>
</div>
<div id="edn4">
<div class="MsoEndnoteText">
<span style="font-family: Georgia, Times New Roman, serif; font-size: x-small;"><a href="file:///V:/097%20JOHN%20McGOWAN/Social%20Med/Steve%20Onyett%20-%20How%20to%20prevent%20tragedies%20like%20Mid%20Staffs3.docx#_ednref4" name="_edn4" title=""><span class="MsoEndnoteReference"><span class="MsoEndnoteReference"><span style="color: black; line-height: 14.949999809265137px;">[4]</span></span></span></a> F<span lang="EN-US">or example the </span>Corporate Leadership Council’s (2004) report <i>‘Driving Performance and Retention through Employee Engagement’ </i>cited in Pendleton, D. and Furnham, A. (2012). <i>Leadership- All you need to know</i>. Basingstoke. Palgrave.<span lang="EN-US"><o:p></o:p></span></span></div>
</div>
<div id="edn5">
<div class="MsoEndnoteText">
<span style="font-family: Georgia, Times New Roman, serif; font-size: x-small;"><a href="file:///V:/097%20JOHN%20McGOWAN/Social%20Med/Steve%20Onyett%20-%20How%20to%20prevent%20tragedies%20like%20Mid%20Staffs3.docx#_ednref5" name="_edn5" title=""><span class="MsoEndnoteReference"><span class="MsoEndnoteReference"><span style="color: black; line-height: 14.949999809265137px;">[5]</span></span></span></a> Alimo-Metcalfe, B., Alban-Metcalfe, J., Bradley, M., Mariathasan, J., & Samele, C. (2008). The impact of engaging leadership on performance, attitudes to work and well-being at work: a longitudinal study. <i>Journal of Health Organization & Management,</i> 22, 6, 586-598<span lang="EN-US"><o:p></o:p></span></span></div>
</div>
<div id="edn6">
<div class="MsoEndnoteText">
<span style="font-family: Georgia, Times New Roman, serif; font-size: x-small;"><a href="file:///V:/097%20JOHN%20McGOWAN/Social%20Med/Steve%20Onyett%20-%20How%20to%20prevent%20tragedies%20like%20Mid%20Staffs3.docx#_ednref6" name="_edn6" title=""><span class="MsoEndnoteReference"><span class="MsoEndnoteReference"><span style="color: black; line-height: 14.949999809265137px;">[6]</span></span></span></a> Losada, M. and Heaphy, E. (2004). The role of positivity and connectivity in the performance of business teams. <i>American Behavioral Scientist</i>, Vol. 47 No. 6, pp. 740-65.<span lang="EN-US"><o:p></o:p></span></span></div>
</div>
<div id="edn7">
<div class="MsoEndnoteText">
<span style="font-family: Georgia, Times New Roman, serif; font-size: x-small;"><a href="file:///V:/097%20JOHN%20McGOWAN/Social%20Med/Steve%20Onyett%20-%20How%20to%20prevent%20tragedies%20like%20Mid%20Staffs3.docx#_ednref7" name="_edn7" title=""><span class="MsoEndnoteReference"><span class="MsoEndnoteReference"><span style="color: black; line-height: 14.949999809265137px;">[7]</span></span></span></a> See McKergow, M., W. (2009). Leader as Host, Host as Leader: Towards a new yet ancient metaphor. <i>International Journal for Leadership in Public Services, </i>5(1), 19-24.</span></div>
</div>
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CCCU Applied Psychologyhttp://www.blogger.com/profile/12127528347937708211noreply@blogger.com13tag:blogger.com,1999:blog-3737633890176949647.post-64375481018870039032014-01-27T11:02:00.001+00:002014-01-27T11:06:48.844+00:00Guest post. The manufacture of madness? Why social construction in psychiatry is not as simple as it seems<div class="MsoNormal">
<i>Huw Green<o:p></o:p></i></div>
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<table cellpadding="0" cellspacing="0" class="tr-caption-container" style="float: left; margin-right: 1em; text-align: left;"><tbody>
<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhd46hR-LMYoF2knkpQdXL_5xt_cmNvRmciR2yR0Zcemk-CpRAsi4Ksleri4GrzGLCcrUhwnhlbYnyB2YlWhDnQjrFdvXCmtV1Aj6hyhZIP3EqP5aSvMo5r1qgRtflRVBrxCurmZjr55IWS/s1600/Lego+construction.jpg" imageanchor="1" style="clear: left; margin-bottom: 1em; margin-left: auto; margin-right: auto;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhd46hR-LMYoF2knkpQdXL_5xt_cmNvRmciR2yR0Zcemk-CpRAsi4Ksleri4GrzGLCcrUhwnhlbYnyB2YlWhDnQjrFdvXCmtV1Aj6hyhZIP3EqP5aSvMo5r1qgRtflRVBrxCurmZjr55IWS/s1600/Lego+construction.jpg" height="137" width="200" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;"><span style="font-size: xx-small;">Mental health problems: Constructed or discovered?</span></td></tr>
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Anyone who has
spent time reading or listening to psychologists recently is likely to have
encountered the idea that mental health problems are ‘social constructs’. What
is meant by this is that entities such as depression or schizophrenia and
personality disorder, which we might ordinarily think of as diseases; are
actually descriptions that flow out of our culture and moment in history. There
may be good reasons for thinking about mental health in this way. Anybody who
claims that there is no social construction involved in the disorders outlined
by the American Psychiatric Association (APA) is unaware of the way the manual
is written. Prior to 1952 there was no DSM, and every 15 years or so since, a
revision has appeared. These updatings are usually chock full of new diagnoses,
many of which have been <u><span style="color: blue; mso-bidi-font-family: Helvetica;"><a href="http://www.npr.org/2010/12/29/132407384/whats-a-mental-disorder-even-experts-cant-agree"><span style="color: blue;">regretted by the very people who helped bring them into
existence</span></a></span></u>.
Indisputable though this may be, it is a form of description which can stand in
the way of understanding the true complexity of such problems. If they are <i>just</i>
constructs then why do so many of the people who experience them find the
experience so like a disorder; so <i>real</i>? In order to be clearer about
this we need to ask exactly what we mean by social construction.<o:p></o:p></div>
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For some
commentators, the implication seems to be that if we stopped talking about
‘schizophrenia’ or ‘personality disorder’, then they would more or less
disappear. This is the argument which Mary Boyle appears to make in the final
chapter of <i><u><span style="color: blue; mso-bidi-font-family: Helvetica-Oblique;"><a href="http://books.google.co.uk/books/about/Schizophrenia.html?id=2geWtCxV4nUC&redir_esc=y"><span style="color: blue;">Schizophrenia: A Scientific Delusion?</span></a></span></u></i> In this line of reasoning, there is much
to be gained from demonstrating that life events, social inequality, abuse, and
even the mental health system create ordinary, understandable distress, which then
gets inaccurately and arbitrarily labelled. It is likely that this depiction is
true in a good many cases.</div>
<a name='more'></a><o:p></o:p><br />
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However, there
are at least two meanings we might intend by saying that something is socially
constructed and it is a distinction that is easy to fudge. In the first sense,
we could be suggesting that social conventions are the only sense in which
something exists (as with, for example, The Human Rights Act, The Premier
League and The Church of England) and that a change in our verbal behaviour could
eliminate it.</div>
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<o:p></o:p></div>
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A second meaning
would be to draw attention to the fact that certain parts of the natural world
cannot easily be spoken about without recourse to elaborate, but potentially
misleading, metaphors. Thus the space-time continuum gets referred to as a ‘ <u><span style="color: blue; mso-bidi-font-family: Helvetica;"><a href="http://backreaction.blogspot.com/2013/10/metaphors-and-analogies-scientists.html"><span style="color: blue;">rubber sheet</span></a></span></u>‘ ; strands of DNA get ‘ <u><span style="color: blue; mso-bidi-font-family: Helvetica;"><a href="http://www.bbc.co.uk/news/science-environment-25815354"><span style="color: blue;">hijacked</span></a></span></u>‘ and the hippocampus ‘ <u><span style="color: blue; mso-bidi-font-family: Helvetica;"><a href="http://wiki.answers.com/Q/Where_does_the_brain_store_memories"><span style="color: blue;">stores</span></a></span></u>‘ memories. These are all
constructs insofar as they are they are linguistically created mental images
which help us imagine what is going on in reality. None of them is
straightforwardly untrue, but if we take them too literally (DNA has never been
held up at gunpoint by a primordial molecular criminal) they give us a
misleading picture of complex processes. <o:p></o:p></div>
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This distinction
between constructs that only exist through consensus and constructs that are
created <i>around</i> real entities and processes, is drawn by the philosopher
of science Ian Hacking who, in his book <i><u><span style="color: #1155cc;"><a href="http://larvalsubjects.files.wordpress.com/2011/01/hacking-the-social-construction-of-what2.pdf"><span style="color: #1155cc;">The Social Construction of What</span></a></span></u></i>,
explores the ways that childhood sexual abuse, mental illness and even rocks
are ‘constructed’ in the latter sense of the word. Much of the debate about the
reality of DSM constructs is tangled up in this distinction. <o:p></o:p></div>
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There exist, to
paraphrase <u><span style="color: blue; mso-bidi-font-family: Helvetica;"><a href="http://en.wikipedia.org/wiki/Tractatus_Logico-Philosophicus"><span style="color: blue;">Wittgenstein</span></a></span></u>, states of affairs in the world. Language meanwhile, is the system we
have for trying to <i>describe </i>those states of affairs. Although the states
of affairs can’t be changed by the words we speak, the way we furnish our world
is no trivial matter, for what we call reality consists both of these states of
affairs <i>and </i>the way we describe them. <o:p></o:p></div>
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So what of this
second meaning of ‘socially constructed’? When we talk about the world we
necessarily translate it into words, conjuring up mental images that move us
away from the reality of the thing itself. Cancer is a ‘real’ physical event,
but it remains true, as Susan Sontag points out in her beautiful <i><u><span style="color: #1155cc;"><a href="http://www.nybooks.com/articles/archives/1978/jan/26/illness-as-metaphor/"><span style="color: #1155cc;">Illness and it’s Metaphors</span></a></span></u></i> that
we speak about it in ways that are unhelpful. Take for example, the suggestion
that people ought to ‘fight’ their cancer, implying that the sufferer can
somehow do something tangible about their illness by sheer will alone, creating
unnecessary misery for people with the disease. <o:p></o:p></div>
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What are the
implications of this second form of social construction for our attempts to
talk about, say, schizophrenia? One important difference is that although we
can still say that schizophrenia is socially constructed, we remain nonetheless
able to entertain the possibility that there is a distinct neurocognitive
‘disorder’ in the organism towards which this construct is legitimately trying
to point. The <i>definition </i>given in the DSM, which has changed in various
ways over the years, is very obviously constructed; a definition after all is
just a verbal attempt to capture some state of affairs in the world. Meanwhile,
the reality (the ‘state of affairs' itself) is something ‘out there’ beyond
language and is <i>not </i>‘constructed’ in the sense we are interested in
here.<o:p></o:p></div>
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If this seems
arcane, we should take it back to the level of the concrete. Psychiatric
diagnosis is in a protracted state of disarray. There exist numerous accounts
attesting to the fact that schizophrenia is frequently diagnosed in people who
not only recover rapidly from their distress but feel the label itself does
them more harm than good (the articulate <u><span style="color: #1155cc;"><a href="http://www.ted.com/talks/eleanor_longden_the_voices_in_my_head.html"><span style="color: #1155cc;">Eleanor Longden</span></a></span></u> and <u><span style="color: #1155cc;"><a href="http://www.tandfonline.com/doi/abs/10.1080/17522430903420729?journalCode=rpsy20"><span style="color: #1155cc;">Peter Bullimore</span></a></span></u> are prominent
examples). Alongside these, there exist accounts (those of <u><span style="color: #1155cc;"><a href="http://www.brainm.com/software/pubs/brain/The_center_cannot_hold.pdf"><span style="color: #1155cc;">Elyn Saks</span></a></span></u> or <u><span style="color: #1155cc;"><a href="http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2632294/"><span style="color: #1155cc;">Peter Chadwick</span></a></span></u> stand as good
examples) suggesting that a Schizophrenia diagnosis <i>can </i>act in much the
same way as the identification of any other disorder, accurately naming a real
problem and flagging up a treatment more useful than any other that has been
encountered. These two possibilities suggest a diagnosis that is overly
inclusive rather than one which can simply be dissolved.<o:p></o:p></div>
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Under this
description, the question is not one of <i>rejecting </i>psychiatric diagnoses
but of <i>improving </i>them, both in terms of their design and in the rigidity
with which they end up being applied in clinical practice. Part of the answer
will lie in finding out the nature of different disabling neurocognitive states
of affairs, how they manifest themselves, and how they are exacerbated by our
social environment. Only when we have done this, can we stop using existing
constructs (DSM diagnoses) and start using a system that resembles not so much
labelling, but diagnosing proper.</div>
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<i>Huw Green is a PhD
student and trainee clinical psychologist based in New York. You can follow him
on Twitter </i><i><a href="https://twitter.com/Huwtube">here</a>. He blogs regularly at <a href="http://psychodiagnosticator.blogspot.co.uk/">http://psychodiagnosticator.blogspot.co.uk/</a>. </i></div>
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<i><br /></i>
<i>Those keen for further
discussion of the social construction and mental health may find <a href="http://www.recoverydevon.co.uk/download/The_Social_Construction_of_Mental_Illness.pdf">this paper</a> by Michael Walker of
interest. (Ed).</i></div>
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CCCU Applied Psychologyhttp://www.blogger.com/profile/12127528347937708211noreply@blogger.com27tag:blogger.com,1999:blog-3737633890176949647.post-87180131906975422932014-01-23T13:43:00.001+00:002014-01-23T13:43:22.965+00:00Athletic identity: Hercules' muscle or Achilles heel?<div class="MsoNormal" style="line-height: 120%; margin-bottom: .0001pt; margin-bottom: 0cm; mso-layout-grid-align: none; mso-pagination: none; text-autospace: none;">
<i><span style="font-family: ArialMT; font-size: 12pt; line-height: 120%;">Izzy Biggin<o:p></o:p></span></i></div>
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<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgvHLViTYdb5f8jgcxLrTLZyW7DFe7VfD48jsFZuAhNH3MnxQusieoIuG8FdRYxq7xB5c8xXqPAbRFAfJ2-Y6jgf3BDX41MVEXYeXEgMssZT8Mao2DQv93Iju-B-CEESn3a_JGH-jilz5tX/s1600/100+metres.jpg" imageanchor="1" style="clear: left; margin-bottom: 1em; margin-left: auto; margin-right: auto;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgvHLViTYdb5f8jgcxLrTLZyW7DFe7VfD48jsFZuAhNH3MnxQusieoIuG8FdRYxq7xB5c8xXqPAbRFAfJ2-Y6jgf3BDX41MVEXYeXEgMssZT8Mao2DQv93Iju-B-CEESn3a_JGH-jilz5tX/s1600/100+metres.jpg" height="131" width="200" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;"><span style="font-family: Georgia, Times New Roman, serif; font-size: xx-small;">Being at the pinnacle brings<br /> it's own pressures.<br />Photo: <a href="http://www.flickr.com/people/ptital/"><span class="given-name" style="line-height: 18px; text-align: left;">Alexandre</span><span style="line-height: 18px; text-align: left;"> </span><span class="family-name" style="line-height: 18px; text-align: left;">Moreau</span></a></span></td></tr>
</tbody></table>
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<span style="font-family: ArialMT; font-size: 12pt; line-height: 120%;">Last November England cricket
batsman Jonathon Trott </span><u><span style="color: blue; font-family: ArialMT; font-size: 12.0pt; line-height: 120%; mso-bidi-font-family: ArialMT; mso-bidi-font-style: italic;"><a href="http://www.bbc.co.uk/sport/0/cricket/25085025"><span style="color: blue;">departed from Ashes tour</span></a></span></u><span style="font-family: ArialMT; font-size: 12pt; line-height: 120%;"> of Australia due to a
long-standing ‘stress-related illness’. This was a shock for some of the media.
Do such things happen to elite cricketers? In contrast, others speculated that
cricket has a particular problem. After all, fellow England batsmen Marcus
Trescothick and Graeme Fowler have had their </span><u><span style="color: blue; font-family: ArialMT; font-size: 12.0pt; line-height: 120%; mso-bidi-font-family: ArialMT; mso-bidi-font-style: italic;"><a href="http://www.telegraph.co.uk/health/10517808/depression-jonathan-trott-graeme-fowler-the-ashes-cricket.html"><span style="color: blue;">own battles with depression</span></a></span></u><span style="font-family: ArialMT; font-size: 12pt; line-height: 120%;">. However, with other sporting
legends, such as boxer </span><u><span style="color: blue; font-family: ArialMT; font-size: 12.0pt; line-height: 120%; mso-bidi-font-family: ArialMT; mso-bidi-font-style: italic;"><a href="http://www.time-to-change.org.uk/news-media/celebrity-supporters/frank-bruno"><span style="color: blue;">Frank Bruno</span></a></span></u><span style="font-family: ArialMT; font-size: 12pt; line-height: 120%;"> and Olympic medallists </span><u><span style="color: blue; font-family: ArialMT; font-size: 12.0pt; line-height: 120%; mso-bidi-font-family: ArialMT; mso-bidi-font-style: italic;"><a href="http://www.gmw.nhs.uk/news/dame-kelly-holmes-champions-new-mental-health-centre-for-young-people-at-launch-event-578"><span style="color: blue;">Dame Kelly Holmes</span></a></span></u><span style="font-family: ArialMT; font-size: 12pt; line-height: 120%;"> and </span><u><span style="color: blue; font-family: ArialMT; font-size: 12.0pt; line-height: 120%; mso-bidi-font-family: ArialMT; mso-bidi-font-style: italic;"><a href="http://www.telegraph.co.uk/sport/olympics/9517671/London-2012-It-can-be-dark-and-lonely-at-the-top-says-Victoria-Pendleton.html"><span style="color: blue;">Victoria Pendleton</span></a> </span></u><span style="font-family: ArialMT; font-size: 12pt; line-height: 120%;">also disclosing struggles with
mental health issues a unique place for cricketers seems unlikely. Given the
particular set of pressures on elite athletes (fame, wealth, expectation),
perhaps it may be more prudent to consider the risks of being at the pinnacle
of physical achievement. <o:p></o:p></span></div>
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<u><span style="color: blue; font-family: ArialMT; font-size: 12.0pt; line-height: 130%; mso-bidi-font-family: ArialMT;"><a href="http://www.mentalhealth.org.uk/help-information/mental-health-statistics/"><span style="color: blue;">Many of us</span></a></span></u><span style="font-family: ArialMT; font-size: 12pt; line-height: 130%;">
will suffer from the kinds of distress that gets labelled a mental health
problem when dealing with the demands of everyday life. Is it really
surprising that elite athletes, with their pressures to consistently perform,
are at risk of developing psychological difficulties too? As icons of physical
perfection it may be that we assume that they have equitable superhuman mental
strength as well. It’s also worth giving some thought to what happens when an
elite athlete is no longer elite. Or what happens when an athlete is no longer
an athlete. What happens on retirement, or when an athlete suffers a drop in
form, is left out of the team, or is injured? When the elite athlete identity,
formed by a lifetime of early morning starts, gruelling training schedules and
countless social sacrifices, is no longer applicable, it would be surprising if
there were not some consequences for self-esteem and psychological well-being.</span></div>
<a name='more'></a><o:p></o:p><br />
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<span style="font-family: ArialMT; font-size: 12pt; line-height: 130%;">Sport psychologists have been bettering athletes’ physical
performance for decades. But who is responsible for maintaining their
psychological wellbeing? The world of sport has been wary of addressing this
issue. However, psychological thinking about the struggles of athletes may be
just as applicable in this area of life as in others.</span></div>
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<span style="font-family: ArialMT; font-size: 12pt; line-height: 130%;">Researchers have </span><u><span style="color: blue; font-family: ArialMT; font-size: 12.0pt; line-height: 130%; mso-bidi-font-family: ArialMT;"><a href="http://sagepub.com/upm-data/5348_Hankin_Final_pdf_Chapter_2.pdf"><span style="color: blue;">suggested</span></a></span></u><span style="font-family: ArialMT; font-size: 12pt; line-height: 130%;">
that everyone has psychological factors that predispose them to developing
mental health difficulties to some degree. It is the interaction between
these factors and the level of stress experienced which determines whether or
not an individual will experience mental health issues. Others have suggested
the important role that identities, such as ‘mother’ or ‘carer’, may play in
maintaining our wellbeing and that the loss of these identities can be
detrimental to our psychological health. There appears no reason why the loss
of the identity ‘athlete’ should be different.<o:p></o:p></span></div>
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<span style="font-family: ArialMT; font-size: 12pt; line-height: 130%;">Whatever the cause of these difficulties, we know that
early detection and intervention can prevent longer-term adverse effects. This
has led some researchers to suggest that sport coaches are well positioned to
identify those individuals who may be experiencing the early stages of
psychological distress and to signpost them to appropriate support. They may
also play a protective role against mental health difficulties for athletes,
providing a source of support and guidance for those who find themselves
isolated by long international tours, training camps and hours on the track,
field or pitch. However, without adequate information and support, are coaches
equipped for this responsibility? Given the unique set of pressures within the
athlete-coach relationship, which some have suggested is unhelpful, are coaches
protectors or part of the problem? <o:p></o:p></span></div>
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<b><span style="font-family: ArialMT; font-size: 12pt; line-height: 130%;">What are your views?<o:p></o:p></span></b></div>
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<span style="font-family: ArialMT; font-size: 12pt; line-height: 130%;">Are you an athlete who can identify with these issues in
yourself or others? Are you a coach who feels that more should be done to
support athletes in this way, or that there is already adequate support for
athletes? I would very be interested in hearing your thoughts as part of an
online research project to gain a greater understanding of these issues. <o:p></o:p></span></div>
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<span style="font-family: ArialMT; font-size: 12pt; line-height: 130%;">If you would like to know more about this research
project, or are a coach or athlete and would like to participate, please
contact me: </span><u><span style="color: blue; font-family: ArialMT; font-size: 12.0pt; line-height: 130%; mso-bidi-font-family: ArialMT;"><a href="mailto:ibigginresearch@gmail.com"><span style="color: blue;">ibigginresearch@gmail.com<o:p></o:p></span></a></span></u></div>
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