What lurks beneath?

John McGowan

Are nice neighbourhoods all they seem?

As those who check in regularly with this blog know we do occasionally manage a bit of culture (films and books), 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.

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 The Good Neighbour 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.

Robin Williams, depression and the complex causes of suicide

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. 

This article originally appeared on the Guardian Science Website on the 18th of August 2014 and is reproduced here with permission.

Anne Cooke, Angela Gilchrist and John McGowan

Photo: Eva Rinaldi

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 “coward” (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.”

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 piece by Guardian science blogger Dean Burnett 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.

The winner takes it all

John McGowan considers the horrors of school sports day and suggests a surprisingly simple remedy

The loser's standing small? Photo: Alethe

‘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?

Is it time to call time on Community Treatment Orders?

John McGowan

The Mental Health Act 2007:
Alternatives to hospital or
 curtailments of liberty?

Every so often I come across an article on Community Treatment Orders (CTOs). Usually the view expressed is critical and it always produces a stab of disquiet. More on the bad feelings in a second, but before that, it’s worth just establishing what we’re talking about. The norm that people with mental health problems can be given treatment against their will and detained in hospital is well established.  In the United Kingdom the Mental Health Act 2007 extended this principle by allowing people such compulsory treatment at home (i.e. without admission). The twinge of unease comes because I, in the face of a good deal of criticism from colleagues, thought this change was a good idea.

Let’s leave aside whether such compulsory powers are right or wrong. Feelings run high but there is no sense in which the abandonment of enforced treatment is on the table. Let’s also leave aside the idea of confining compulsory treatment to cases where people lack the capacity to consent. Unlike physical health (where any of us has a right to refuse treatment unless we lack capacity) the UK the Mental Health Act allows treatment on the basis of   mental illness While there are powerful arguments that this situation is unjust, these have struggled to gain traction.  Here I want to focus on the narrower question of whether, in a world were compulsion is established, CTOs have been helpful.

In praise of Alfie

John McGowan

Rock solid childhood friends
Photo: Jordy Theiller

The Big Alfie and Annie Rose Storybook ambushed me the other day. It was sitting in the window of a charity shop while I was on my way somewhere. Sentimentality can get you when you’re least expecting it, especially where the children’s author Shirley Hughes is concerned. One minute you’re thinking about what you need from the chemist, and the next about how long it was since you’ve read to your kids, and why the little pests have to grow up so quickly. But they’re off to chat to their mates online and don’t care that you are left clasping a book with a hopeful expression. It helps – a bit – to know that you’re far from the first to go down this road. Literature and modern culture abound with examples. From Peter Pan to Toy Story, it’s clear that leaving behind childish things can be painful; sometimes for the one growing up, but more often for those around them. Is it possible to watch Jessie the cowgirl being thrown out by her owner, without reaching for the tissues?

A recent exhibition of Shirley Hughes’ art suggests that she is predominantly viewed as an illustrator. She has twice won the prestigious Greenaway Medal for illustration and, a few years ago, was asked by Sarah Brown to design the Downing Street Christmas card. I’m not sure that her artwork, beautiful  though it is, completely accounts for my little crisis en route to the chemist, though. Perhaps a more plausible reason is that, while Hughes’ images are memorable, it’s as a writer that she stays with me; as someone who supremely conjures up a world of childhood joys, fears and transitions.

Is Life a Disease?

Anne Cooke and John McGowan

The DSM makes a handy lectern
Photo: Maciej Janowicz

As regular readers of this blog know, we are very interested in the pros and cons of psychiatric diagnosis. We try to discuss this issue in an accessible way and reach as broad an audience as possible. It was a great pleasure, therefore, to be invited by Lewes Skeptics (a Sussex branch of the Skeptics in the Pub network) to give a talk about mental illness, diagnosis, and some of the controversies raised by the new version of the psychiatric classification manual DSM-5. We've since been asked to make the talk available more widely, so we've posted it below. It's a video of the slides, accompanied by a soundtrack recorded on the night.

It was interesting to see that the event sold out in a few days. Since we’re hardly big names, we hope this says something about the level of public interest in mental health. The same happened the last time that the Skeptics put on a mental health-related talk (by psychiatrist Joanna Moncrieff), so something clearly strikes a chord. On the night of our talk the room was jammed, the temperature was hot and the controversy even hotter! Actually that last bit isn’t true. The debate was conducted in the most civil and decorous manner - not always easy when passions on this topic can run high.

We’d like to thank Lewes Skeptics (and in particular Eugene Gill) for hosting the event, and for their commitment to promoting public engagement with important topics. If you want to know more follow them @LewesSkeptics on Twitter. We are also grateful to John Warburton man of many parts, two of which were his very strong forearms. The fortitude with which he acted as a human boom for the recording equipment was admirable. Thanks also to the audience. The pub patrons of Lewes are clearly a thoughtful lot.

You can view the video either in the embedded version below or via the direct link on YouTube. 

There is also a recording of the discussion following the talk. The quality is slightly more variable as questioners were sitting in different parts of the room. The Q&A audio is embedded below or you can listen to it directly on Sound Cloud.

A just world

John McGowan

Make sure you get the pieces the same size.
Photo: Klipy Design

‘Daaaaaaad! You let Sam on the computer. IT’S NOT FAIR!’

So goes the soundtrack to the summer holidays. Rather than scrambling to put dinner on the table, get in the washing and manage my job (in half the usual time and without the aid of school) my top priority is to ensure parity between my children. How could I have possibly forgotten? There shouldn’t be a cigarette paper of difference in terms of equality; activities must be balanced for treat-magnitude with the judgement of Solomon. Other than of course the finely calibrated extra privileges that accrue to the my older one as a result of seniority and long service. Long service, you understand, consists of having been demanding for longer and it all counts in the great ledger that I clearly failed to check.

The importance of fairness seems to trump all other considerations, including self-interest. Give Child 1 £1 and she’ll be happy. But if she finds out Child 2 has £1.50 she’ll be angry. Take the money away from both and she’ll be satisfied. Child 1 has lost out but Child 2 has lost more so all’s right with the world. In my frazzled state it can feel like my kids are simply brats who live to make my life difficult. A more considered look at the evidence however tells a different story. Other people’s kids do the same. Always a relief. In fact research suggests that, though they may be more obvious about it, it’s not just children who have a profound (and sometimes self-injurious) aversion to unfairness. Behavioural economists Fehr and Schmidt (1999) have gone as far as to suggest that ‘willingness to sacrifice potential gain to block another individual from receiving a superior reward’ is basic to the human condition.

The real trouble with magic

John McGowan

A magical sidekick for parents?
Picture: Izabella at deviantart.com

“Mummy, am I fat?” says my daughter, all of seven, regarding herself in the bath. She doesn’t know it yet but body fascism is my wife’s darkest fear. The thought of a little girl worrying about weight evokes a response like that of a vampire facing a crucifix or Lady Gaga being asked to wear a twinset.

“No darling you’re not, and it’s a silly thing to worry about”, my wife replies with admirable (though bogus) insouciance. After a couple of minutes of intense debate the crisis is over and worries about the Messages Kids Get Today are, at least temporarily, averted.

“You promise you’re telling me the total, absolute truth Mum?”

“Of course sweetheart. I’ll never lie to you when you ask me for the truth. Cross my heart and soak my sleeve in this bubble bath”.

I slip out of the room, failing to hear the scream of a gigantic hostage to fortune being abducted right beside me.

Halfway down the stairs the other shoe drops.

We Can’t Let Maggie Go

John McGowan

Feelings about Maggie fade slowly
Picture:  Trevor Rickard 

Like many middle-aged Brits I came to political sentience chanting, ‘Maggie, Maggie, Maggie...’ followed by some general abuse inviting Mrs Thatcher’s exit. It was all so easy. Hating the Tories in general, and Mrs T’s economic brutality in particular, was as natural as breathing. For all the economic and social divisions, 1980s Britain was a straightforward place to grow up.

Mrs Thatcher having gone is one of those life-marking moments. Like when your parents would say, ‘Of course you’re too young to understand’ and find someone who remembered the charts before the Beatles. I need to talk to someone who actually remembers the ‘no such thing as society’ quote, the declaration that Nelson Mandela was a ‘terrorist’ or that some people thought Michael Foot would be a credible prime minister. I think I’m looking for some sort of grounding in the face of the incredible passions the Iron Lady still arouses. The nation is again split from top to bottom,or possibly between top and bottom, and the spirit of ‘83 roams the land. Was she really so bad though, I ask my friends? Most of them think it she was worse. Despite this plenty of my Thatch-hating mates operate small businesses, pay Rupert Murdoch for Sky TV, and live happily in a world created in the laissez-faire 80s rather than the socialist 70s. A little inconsistent perhaps? Maybe instead it’s that an overwhelming focus on Mrs T’s personality and her triumphs or sins glosses the possibility that the 80s weren’t so straightforward after all.

100 days after Sandy Hook and guns still protect you (apparently)

John McGowan

Even modest gun law reform in the USA is faltering. Despite there still being plenty of outrage around, and national support for change, not enough members of Congress in areas committed  to gun rights see the benefits of voting against the will of their constituents.

Looking less and less likely.
Image: Arthur Smart (Talk)

The pro and anti arguments are lined up very much in the way I described in January. President Obama, Michael Bloomberg, and the more progressive commentariat are leading the charge for increased restrictions with the idea that a large number of firearms in circulation is ultimately bad for public safety. This is compounded, they argue, by some of these weapons being automatic, high capacity guns, sold without thorough background checks on buyers. The opposing position, articulated by the National Rifle Association, values freedom, training people to use firearms and, crucially, a need for personal protection, if necessary by lethal force, in a world where criminals may be armed.

Silver Linings: Is Sickness a Shield Against Stigma?

John McGowan

Silver lining or more rain?
Photo: By Im Unicke

I’d been avoiding Silver Linings Playbook. Nothing against it particularly, it’s just that Very Serious films about mental health always feel like a busman’s holiday. I got corralled into seeing it by the missus though, more observant than me, who had clocked that a) it was warmly sentimental, and b) it featured a dance contest. These days plucky young hoofers channelling Patrick Swayze are all I ask of a film. And if someone is also (spoiler alert) saved by the love of a good woman, then my cup runneth over.

As well as Jennifer Lawrence’s Oscar, the talk on the internet has been about how realistic SLP is (or isn’t), and what it tells us about social attitudes to mental illness. Opinions are split between those who see it as a ground-breaking and nuanced portrait of people having emotional difficulties, and those who view its happy ending as idealised and simplistic. Lawrence has been lauded for her portrayal of Tiffany, the aforesaid good woman, who is frequently a bad girl as she seeks to drown the pain of widowhood. This makes her, according to your point of view, either an ideal candidate or the worst possible bet to get things together by dancing/falling in love with fellow recoverer Pat (Bradley Cooper).

Gazza, Lance and the difficulties of psychiatric diagnosis

John McGowan

What do you call someone who tells lies persistently? In recent weeks the answer is probably Chris Huhne, the latest in a line of hubristic politicians who have told a stream of big porkies to cover up a small one. You may have already forgotten that before the erstwhile next leader of the Lib Dems bowed out, the deceiver du jour was cycling champ (technically ex-champ) Lance Armstrong. I've written about the ethics of Armstrong’s fall from grace elsewhere, suggesting that, while his doping to win the Tour de France wasn't great, his unpopularity has far more to do with his deceit and with our disappointed expectations of a previously heroic figure.

Pinocchio. Worrying signs of psychopathy
in childhood! Picture:  Ropa-To.

However, what should we call him? Is he a ‘jerk’ (his own suggestion), or one of many more colourful names suggested on various comment threads of the web? As well as the stream of abuse, some of Lance’s ex-fans also seem eager to offer a more nuanced appraisal in the form of psychiatric labels. Is he a psychopath or a sociopath or, as an article in the Atlantic a couple of weeks back suggested, an ‘aggressive narcissist’? What, I wonder, do these labels tell us about him that conventional monikers do not?

Do guns protect you?

John McGowan

Since the Newtown school shootings it’s hard to remember such an outpouring of antipathy towards guns in the United States. After Columbine maybe, but I’ve never heard a right-of-centre US politician be as forthright as New York Mayor Michael Bloomberg after the killings at Sandy Hook:

“And it happens again and again… We kill people in schools. We kill them in hospitals. We kill them in religious organizations. We kill them when they’re young. We kill them when they’re old. And we've just got to stop this.”

It’s beginning to look like President Obama will produce a more concrete response than tears, and the fight for restrictions to gun ownership laws is likely to be one of the defining political battles of this coming year in America. 

It’s not clear that there is a straightforward link between outlawing gun ownership and a fall in gun-related fatalities. Changed laws in Australia have provoked impassioned debate over what the effects have been and why. What is clear is that firearms availability (legal or otherwise) is associated with high rates of death by shooting (see a useful summary here). The lesson from the Australian example is that legislation is not the only priority. If people still want guns, then gun-related death rates may remain very high, even in a situation where restrictions on availability are in place.  A more productive strategy is to change the law and seek to develop a different culture around firearms. Changing one may help to change the other and vice versa. In the case of America, to achieve both of these aims it would help to understand the attachment of many US residents to guns.  From the perspective of someone who lives in a society with highly restricted gun ownership this can be absolutely mystifying.  Why does the US love-affair with deadly weapons continue? After wading through coverage of the Newtown shootings I’d propose two main reasons.

Making sense of suicide

John McGowan

“I've danced with a man, who's danced with a girl, who's danced with the Prince of Wales” went the 20s song, written before Edward VIII became King and took a dip in popularity. The case of Jacintha Saldanha, who put through a call to someone who gave out information about the Duchess of Cambridge, ended far more tragically than for the flapper chanteuse. Our hunger for remote royal associations however, seems undimmed.

Speculation about Ms Saldanha (who did not appear to have courted any sort of publicity in her life) has been rampant on a global scale. Her suicide led to a huge array of responses: compassionate neutrality on the part of the royals, self-flagellating guilt from the pranksters, outrage about the lack of support for the family, and consideration of the limits of free speech. 

How are we to understand such an act? Not just in this case but whenever it happens? The possible risk factors for suicide are multiple. Also, as I have argued elsewhere, the potential motivations behind suicide and self-harm are manifold and complex. The act may be about escape, release, anger, revenge or a host of other feelings. It may be accidental, perhaps the seeking of care or an expression of desperation that has gone wrong. People’s motives can be shifting and not always evident, even to themselves. At this stage we don’t actually know if Ms Saldanha’s death was linked to the prank call.

Welcome to the Salomons Blog

John McGowan

Watch this space for thoughtful consideration of what's going on in psychology, mental health and the dear old NHS.

I'm guessing there is plenty to say. 

Submission Guidelines

Most of the articles appearing on Discursive of Tunbridge Wells are solicited. We don’t have the time or resources to read unsolicited articles. However, if you have an idea for a piece you’d like to write you can pitch it to us by emailing cccuappliedpsychology@gmail.com. The rules are as follows:

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