Letters, March 2012

Speaking out at times of threat to NHS

We write, as psychologists, patients and other health professionals in the south west of England (and beyond), in support of the position of Dr Khadj Rouf ('An erosion of rights and patient care?', Letters, January 2012) and others (Dave Harper and colleagues, Letters, October 2011; Jim Orford, Letters, July 2011) that the British Psychological Society (BPS) should help raise awareness of what is happening to public services, as part of its commitment to social justice. We, along with informed commentators and expert analysts, believe that the Health and Social Care Bill has no democratic mandate, is incoherent and unnecessary, will put profit before patient care, widen health inequalities, fragment care provision, and break down trust between patients and staff (Leys & Player, 2011; McKee, 2012).

We read in The Observer ('Listen to the experts, Mr Lansley – your reforms are wrong', 22 January 2012) that the Royal College of Nursing, the Royal College of Midwives and the Chartered Society of Physiotherapy joined the British Medical Association, and the Royal College of GPs in calling for the entire Bill to be thrown out. It is troubling that the professional body for psychology, which professes to promote people's well-being, has not yet spoken out to defend one of the nation's most cherished institutions (and one of the most efficient and effective health services in the world, according to robust evidence (Pritchard & Wallace, 2011)) from the competition and commercialism that the Bill ushers in.

Neville Osrin (Letters, November 2011) notes that we do not know how many BPS members might oppose the Bill. This is because the BPS has not surveyed the membership to find out.

A survey conducted by the Royal College of General Practitioners found that 98 per cent of respondents thought that their professional body should call for the Bill to be withdrawn, as part of a joint approach with other colleges. Would psychologists be very different in their views? We hope not, and we want to find out.

We have set up a branch of Keep our NHS Public South West, membership of which includes patients, carers, medics, academics and psychologists. A jointly signed letter reached the front page of our local press, with an editorial noting that when patients and professionals across disciplines speak out together, it is time to sit up and take notice. We call on the leaders of the BPS to sit up, take notice and take action: ballot the membership and, if the membership is against the Bill, speak out, in partnership with patients and other concerned professions, against the Bill, while there is still time to stop it as it progresses through the Lords. Public and professional opposition to this ill-fated Bill is still mounting – let's add our voices, before it is too late.

Annie Mitchell

School of Social Science and Social Work

University of Plymouth

and 17 other signatories

References

Leys, C. & Player, C. (2011). The plot against the NHS. Pontypool: Merlin Press.

McKee, M. (2012). Who understands the government's plan for the NHS? British Medical Journal, 344, 35.

Pritchard, C. & Wallace, M.S. (2011). Comparing the USA, UK and 17 Western countries' efficiency and effectiveness in reducing mortality. Journal of the Royal Society of Medicine Short Reports, 2, 7, 60. doi: 10.1258/shorts.2011.011076

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As a Chartered Psychologist and Unite the Union workplace representative, I totally agree with Dr Khadj Rouf (Letters, January 2012). As Dr Rouf suggests, the strike was not just about public service pensions. Although it is difficult to say how many psychologists joined the public sector strike, I know that I was not joined by any of my colleagues from psychological services on the picket line at my place of work in a CMHT. Rather, it was my colleagues from other disciplines who joined together to stand up for the rights of the most vulnerable people in society to decent services and end the fragmentation of the NHS. The loss of a day's pay or threat of interruption to continuous pension rights did not deter us.

Interestingly, many of the pickets were not union activists or had strong pro-union views. Rather, I would argue that they were a minority who were acting on individual matters of conscience. Studies of fear and bystander apathy have highlighted the importance of independent thinking and action rather than relying on group consensus. Choosing to think well of ourselves as members of the British Psychological, or any society with good intentions, is not the same as taking action. The road to Hell is of course paved with good intentions. I would like to see The Psychologist and BPS forums publish more of members' individual views and matters of conscience and thus raise awareness of what is happening in the profession.

Tom Elliot

Margate

Society President Carole Allan responds:

The Society has in fact responded in a variety of ways.

The Society, in its response to Professor Steve Field's NHS modernisation 'listening exercise', expressed major concerns at the implications of the Health and Social Care Bill. We believe that modernisation of the commissioning arrangements is necessary, but we believe this should involve multidisciplinary panels, not only GP consortia.

Professor Field was invited to attend the Division of Clinical Psychology's annual conference in December 2011.

He presented an overview of the new commissioning process which the Society had criticised as too narrow in focus if led solely by GPs. He said that proposals to broaden the expertise, including psychology professionals within commissioning consortia, have also come from a wide range of health service groups and have now been reflected within a number of amendments to the Bill.

However, the Society's fundamental concern is that patients frequently have complex medical and psychological needs, and require services that work together both within and across organisational boundaries. In their responses to the listening exercise, members of the Society's Divisions of Clinical, Counselling and Health Psychology said that Monitor should have an obligation to ensure equity and quality of service, rather than the promotion of competition.

A survey of members of the British Psychological Society's Division of Clinical Psychology reported in June 2011 revealed 95 per cent of those polled believe the Bill will have a detrimental effect on frontline NHS services. In addition, the study showed 88 per cent of respondents think patients will be negatively affected by the proposed reforms – which were first introduced into parliament on 19 January 2011.

I remain concerned that the Bill as it currently stands still proposes an unregulated competitive model for services which will consume NHS time, money and resources from the overriding need to provide high-quality, integrated care for some of the most vulnerable groups within our communities.

I have written to the Secretary of State for Health setting out the Society's concerns. For the full statement, see www.bps.org.uk/healthsocialcarebill.

Praise and criticism

I write in response to the article 'Praises – five a day for young children' (January 2012). As a schools psychologist (and as a parent), I found this advice valuable: Name a child when giving praise ('That's nice picture you have done, Jimmy') and do not use their name when giving criticism but make your comment generic or 'anonymous' ('Stop that!' 'No shouting!' 'You with the red jersey, stop poking others!' 'It could have more care taken over it.').

Children need criticism too. One child rebelled in a permissive school ('No matter what I do, they say it is wonderful!'). But some children get named only for wrong things, and associate themselves with wrong-doing. 'Rosa!' 'Rosa!' Find five good things and give their name to them. 'You are very good, caring for your baby sister, Laurie.' 'Hitting is a bad thing to do.' The child identifies himself/herself with the good, and the bad things they do are not linked with their identity.

Dr Valerie Yule

Mount Waverley

Victoria, Australia

The roots of horror – a sequel

May I add a word to Morris and Fasulo's objections (Letters, January) to the sort of pseudo-explanation offered, as they say, in a recent article about 'the roots of horror' and the origin of fantasies about person-eating monsters? They rightly and opportunely question the value of a type of explanatory account, currently fashionable, which they call the 'Standard Biological Scientific Model' (SBSM). While endorsing their complaint that such accounts are too often cobbled up from a combination of quasi-evolutionary fantasy and trendy MRI-fixation, I would go further and ask what, for the purposes of explanation (as opposed to manipulation), do technicolor MRI displays ever provide in a wide range of such cases – apart from what W.S. Gilbert called 'a source of innocent merriment'?

More positively, I would suggest that we turn our minds to a different kind of 'evolutionary' story, still ultimately Darwin-based, which proposes that the growing child's psycho-biological development passes through a series of instinct-driven and anxiety-ridden stages; and that the quality of adaptation achieved to each successive challenge has a unique influence on adult functioning. At one of the infantile stages, according to Melanie Klein's version of the story, the baby deals with her/his oral-destructive impulses by projecting them onto things 'out there' (including people), by which she/he may then feel threatened.

One of the Kleinians (either MK herself or Susan Isaacs, I think) reports the case of a pre-verbal toddler who became irrationally terrified of a broken pair of slippers that her mother would wear about the house. So the slippers were consigned to the back of a cupboard, only to be discovered a few years later by the now-verbal child. She pointed to one of them, with its sole gaping loose from the upper, saying 'That slipper might have eaten me up!'.

Perhaps this is the stuff that monsters are made on.

Dr Neil Cheshire

Colwyn Bay

A troubling name

In the same week that the government proved its commitment to tackling stigma by investing 20 million pounds in the Time to Change campaign, it also proudly introduced its new Troubled Families Team to the public. The team, as indicated indiscreetly by its title, has been set up to provide support to 20,000 of Britain's 'most troubled families' and will be led by Ms Louise Casey, CB and Rt Hon Eric Pickles, MP.

As a psychology graduate working in a CAMHS service, I have several strong concerns about the team's title. Whilst explicitly showing the taxpayer what their money is intended for, I fear it may render the team powerless to actually fulfil any of its well-intentioned work, as a result of the psychological reactions the title unwittingly evokes:

- The term 'troubled' has negative connotations and is thus stigmatising to those families it seeks to assist.

- Being labelled by an external agency is likely to result in psychological reactance (Brehm, 1966), whereby a family, feeling the perceived restriction of the freedom to label themselves, would experience a motivating pressure toward re-establishing that freedom. (Heilman & Toffler, 1976) and thus be less willing to engage with that agency.

- Being identified as one of Britain's 20,000 'most troubled' families is likely to activate defence mechanisms, designed to ensure maintenance of positive self-identity and ingroup status (social identity theory: Tajfel & Turner, 1986).

- Considering literature around solution focused therapy (Berg, 1994), keeping the onus on 'troubled' might also slow any progress that those families who do engage in the support make .

I detailed these concerns to the Department for Communities and Local Government and received a reply expressing there were 'currently no grounds to revise the title and it remains the chosen term to describe the Government's commitment in respect of this agenda'. One lone voice is obviously insufficient in this respect, and I am therefore writing to share my concerns with readers, in the hope of ascertaining whether others share them.

I feel strongly that public money should not be wasted by potential help being rendered psychologically inaccessible.

Olivia Fakoussa

High Wycombe

References

Berg, I.K. (1994). Family based services: A solution-focused approach. New York: Norton.

Brehm, J.W. (1966). A theory of psychological reactance. New York: Academic Press.

Heilman, B.L. & Toffler M.D. (1976). Reacting to reactance: An interpersonal of the need for freedom. Journal of Experimental Social Psychology, 12, 519–529.

Tajfel, H. & Turner, J.C. (1986). The social identity theory of intergroup behavior. In S. Worchel & W.G. Austin (Eds.) The psychology of intergroup relations (pp.7–24). Chicago: Nelson-Hall.

Obituary: Professor Jon Driver (1962-2012)

 

Jon Driver was one of the world's leading cognitive neuroscientists. A consummate experimentalist, he left an abiding impression of his intellectual energy and passion for neuroscience on all who met him.

Jon read experimental psychology at Oxford University. Graduating with a first class degree in 1984 he progressed to a DPhil, awarded in 1988. Oxford was full of impressive role models and he thrived in the intellectual energy of this environment. His DPhil supervisors, Alan Allport and Peter McLeod, gave him contrasting examples of scholarship and realism, but also left him to pursue his own devices. This freedom led him to finesse his rapidly developing skills in designing and conducting ingenious experiments that addressed fundamental issues in the psychology of attention. His reputation as a rising star was already apparent by the time he completed his graduate studies. During a period as a visiting assistant Professor in Oregon in the early 90s he experienced first-hand the dynamism and more informal style of US science. Here he met his future wife, Nilli Lavie, also a psychologist.

Returning to Cambridge as a lecturer, his academic trajectory was firmly established. In the late 1990s he moved to Birkbeck College and then to University College London (UCL). Jon was by this time acutely aware that experimental psychology was a discipline going through a crisis brought on by the rising dominance of new brain-imaging technologies and the emergence of the new discipline of cognitive neuroscience.

Jon embraced the possibilities afforded by these developments, realising that brain imaging afforded a powerful means of arbitrating between different psychological hypotheses.

He was appointed a Professor in Psychology in 1996 and became Director of the UCL Institute of Cognitive Neuroscience in 2004. As Director, Jon realised a new talent, bringing in many very able scientists and unobtrusively creating a dynamic, stimulating but caring environment. Typically generous with his time, he played a leading role in the successful UCL bid for the Sainsbury-Wellcome Centre for Neural Circuits and Behaviour. In 2009 he stepped down from the ICN Directorship following an award of a Royal Society Anniversary Research Professorship and joined the faculty of the Wellcome Trust Centre for Neuroimaging at UCL.

Jon's work was distinguished for his pioneering studies of human perception, selective attention, multisensory integration and spatial cognition. He shed important new light on normal human brain function and on disabling cognitive deficits after brain injury. A characteristic feature of his work was the innovative combination of new methods for studying the mind and brain in an integrative manner. Among his many discoveries he showed that early human sensory processing is modulated by a variety of higher-level factors, including segmentation, selective attention, inputs from other sensory modalities, and emotion. Correspondingly, he revealed how damage or disruption to specific higher brain centres supporting these processes impacted causally upon function in lower sensory brain areas. The combined impact of his approach allows successful characterisation of causal influences between remote but interconnected regions in extended networks of the human brain, work that Jon continued to push forward with his development of simultaneous TMS and fMRI.

But it was not just for his scientific discoveries that he will be remembered. His incisive intellect, critical questioning and occasionally mumbling delivery would often intimidate new students, though they rapidly realised he cared deeply about their careers. He gave freely of his time not only to his immediate group but also to the wider neuroscience community. The combination of humility and intellect left a powerful impression on his many colleagues and friends, as did his engaging smile and his twinkling eyes. In a recent interview he said of his field that 'the best research in psychology is still to come'; few would doubt that was also true of his own work.

To leave a memorial message, go to http://jondriver1962-2011.blogspot.com

Professor Geraint Rees

UCL Institute of Cognitive Neuroscience

Professor Ray Dolan

Wellcome Trust Centre for Neuroimaging, UCL

Peter Francis Charles Castle (1922-2011)

Peter Castle went up to Trinity Hall in October 1940, upon receiving an Exhibition. A year later he volunteered for the Navy where he saw active service for five years, gaining the rank of Lieutenant. In October 1946 he resumed his studies at Trinity Hall as a Scholar of the College and gained first class honours both in his Prelims and in his Finals of Moral Sciences Tripos, Part II (Psychology).

He then continued his studies in industrial psychology and industrial relations at the University of Pennsylvania, Philadelphia, and at Birkbeck College, where he gained his PhD in 1952.

Dr Castle was employed by the National Institute of Industrial Psychology, London, during his doctoral studies. After three years at Kodak, he took up a position as an International Civil Servant at the International Labour Organization headquarters in Geneva, where he worked until his retirement. As he wrote in a chapter in a book on management skills, when he joined the ILO, in 1956, he pinned his hopes 'for a better world on a vision of a new world order founded on international organizations and based on international law'. In the sixties, he enjoyed going to Africa to recruit new members from new countries. But the seventies were difficult and, in 1977, demoralization prevailed when the USA cut off funds to the ILO and his dream of a new world order faded completely.

Once retired, he opened a small antique shop, Castle Antiques in the old town of Lausanne, Switzerland. Dr Castle was a Fellow of the British Psychological Society.

Dr Michele Klein

Rehovot

Israel

Forum: Twitter debate

This month's question via @psychmag - 'Compared to the human brain, the universe is a clockwork toy' - Jonathan Miller (author, theatre and opera director, neurologist). Discuss.

@ProfBrianCox Drivel. The brain is a structure within the Universe, operating in accord with the laws of physics.

@profbrucehood @ProfBrianCox 'The brain is a structure within the Universe' – so what? that's a non sequitur.

@OpenCounselling Excited by the unending possibilities of the human brain. Does free will exist & make the brain more unpredictable than universe?

@James_Albins The mind is like gravity. We know it exists, we can feel its effects but it has no physical form and no one know what it is.

@ajjolley Surely both Brain and Universe are effectively infinitely complex, comparisons are moot?

@MoralPsychLab Maybe... If the clockwork toy is so complex it inspires heated arguments about whether its maker was blind, or exists at all.

@keith_wilson It puzzles me when scientists claim the brain is the most complex object in the universe. What about the *entire* body?

@Mike_Page Obvious bollocks: Universe contains brains!

Join the debates by following @psychmag at www.twitter.com/psychmag

Forum: the real world

Those readers who follow this column closely may recall that in February 2009 we wrote about the glass cliff — discussing work by Michelle Ryan and colleagues which has shown that, although women and members of minorities often have difficulty gaining leadership positions, this is less true when organisations themselves get into difficulty. Indeed, when organisations hit the skids, evidence from a large number of archival, survey and experimental studies indicates that (previously disadvantaged) female leadership candidates have an advantage over their male counterparts.

Since we first wrote about this phenomenon, evidence of its broad relevance for organisations and society has been provided from studies in a range of domains (e.g. organisations, law, politics, even academia), in a range of countries (e.g. UK, USA, the Netherlands, even Iceland), and for leaders from various low-status groups (not only women, but also ethnic and disabled minorities).

Most recently though, researchers have started to follow the trajectory of leaders who get appointed to glass cliff positions, and the chain of events that unfold after their appointment – and the news is grim. For example, in his recent book The Last Male Bastion: Gender and the CEO Suite in America's Public Companies Douglas Branson looks at the experience of women like Carly Fiorina, who took over at the helm at Hewlett Packard, after the company had encountered choppy water in the late 1990s. Her time as CEO was turbulent, and after five years she was ousted by the board amid a hailstorm of invective in July 2005. Her replacement, Mark Hurd, was widely heralded as a saviour who had rescued HP from the abyss into which it had sunk under Fiorina's stewardship. As the New York Times wrote, Hurd had 'refocused the strife-ridden company', and 'pulled off one of the great rescue missions in American corporate history'.

Unremarkable perhaps, but a series of more recent studies of leadership in sporting, organisational and political domains reveal this to be a common pattern: Woman (or other minority member) gets appointed to leadership role in crisis; crisis continues; woman (or other minority member) is ousted and replaced by a man who is cast as a saviour; natural order is seen to be restored. This is the case even when the saviour turns out to be a serious disappointment. So never mind that Hurd cut employees' pay by 20 per cent, that he laid off 10 per cent of the workforce, that HP's fortunes failed to improve, and that in 2010 he had to resign himself (albeit with $12m in severance pay) following a sexual harassment scandal. The salvation story is powerful enough to wash away uncomfortable truths about so-called saviours.

So why are we sharing this with you now? Well, as several commentators have remarked, possibly the most significant glass cliff appointment in recent years was that of Barack Obama to the White House (remember too that his most credible opponent was a woman).

The global crisis that pre-dated Obama's appointment has not abated. So watch out for the Republicans mobilising salvation narratives in the upcoming Presidential election. Look carefully as they drop racialised hints that Obama is less of a natural American leader than they themselves. The one consolation is that as Romney, Gingrich and other Republicans battle it out to take on Obama, their exposure of each other's shortcomings makes claims to messiah status look increasingly unconvincing.

Steve Reicher is at the University of St Andrews. Alex Haslam is at the University of Exeter. Share your views on this and other 'real world' psychological issues – e-mail [email protected].

An archive of columns can be found at www.bbcprisonstudy.org.

Forum: beyond boundaries

I'd like to talk about people who don't have minds. This isn't going to be one of those ingenious philosophy arguments where I claim that we're all zombies, nor a smug assertion that we're just a bunch of neurons, but a brief visit to people who genuinely don't have minds – at least not as we understand them.

The idea that the self can be split into body and mind is at the root of psychology, but there is no laboratory test, questionnaire or brain scan that tells us this – it is a product of our culture. In fact, we inherited the notion from the Ancient Greeks and it has stuck with us because we find it convenient (presumably, a bit like stuffed vine leaves). If you're not sure how we can possibly think about ourselves without thinking about the mind, it will be easier, perhaps, to briefly touch upon other forms of psychology where the mind does not exist in the form we understand it.

In traditional Haitian culture, there is no direct equivalent of the mind. The self is made up of a three components. The corps cadavre is the physical body; the ti-bon anj or 'little good angel' loosely represents what we would consider as agency, awareness and memory; while the gwo bon anj or the 'big good angel' is the animating principle that manages motivation and movement. Incidentally, a traditional Haitian zombie is created when a sorcerer steals the 'little good angel' leaving a coordinated body capable of understanding and following instructions but without reflective thought, clearly demonstrating a split where we see a single mental realm.

The traditional Javanese concept of the self, a synthesis of many Eastern influences, is even more complex. Humans consist of the selira or body which is the source of physical desires. The organic structure is kept active and alive by the atma (energy), the kama (sensory desire), and the prana (vital principle). Unlike other beings, humans also have manas (deliberate thinking), manasa (intellect) and jiwa (immortal essence).

We often assume that understanding other cultures is about comprehending how other people 'think' about the world, when many other cultures do not even have an equivalent concept of the mind. Consequently, Western psychology is about as culturally neutral as Coca Cola.