Letters, November 2013

Moving forward from austerity

I read James Anderson's opinion piece ('My manifesto in an age of austerity', September 2013) with enthusiasm and hopelessness, and I have a suggestion.

Sometimes I feel, in my work with individuals, that the mental health system 'falsely attribute[s] cause or agency to the individual'. This does not sit well with me. It is at those times that I reflect on community psychology perspectives and feel energised to tackle poverty, powerlessness, stigma and lack of social connectivity.

Such reflections are encouraged on the training course and in the (relatively affluent, left-leaning) social environment within which I live. As I bounce ideas off like-minded people about how the world 'should' be, I become rather excited. I begin to envisage a society where everyone has the rich community resources that are available in my small village. Then, as I start thinking about practicalities, I begin to feel deflated. In the wake of my excitement, I end up feeling nauseated by my powerlessness in the face of complex societal, cultural and economic problems.

The familiar sensation of excitement and urge for action overcame me when I read Mr Anderson's manifesto. I enthusiastically endorse his first point. I would argue that within any service, it is possible and desirable to 'strive for a more authentic practice' by acknowledging additional causes for distress beyond individual factors.

However, the equally familiar feeling of powerlessness and disappointment soon kicked in. Mr Anderson's second point is about individual and collective power, and he vows to 'speak to the need for strong communities, gainful occupation, sense of equity along with the shared sense of purpose that makes for healthy people and society'.

I agree wholeheartedly with this, but how exactly do we achieve this? What are the forums? What impact can we really have? His fourth point, similarly, left me wondering what to do. What exactly does 'collective action with my patients' mean?

His third point was perhaps the most disheartening – because, I think, I agree with it so much. I want to 'make judgements that directly influence the material quality of people's lives'. I really do. On placement in a deprived part of Milton Keynes, I felt ashamed and powerless in the face of financial and social deprivation. But I didn't know what, if anything, I could do about it. I reflected on it with peers and in supervision, but no one knew, although everyone acknowledged the role of inequalities.

Inequalities exist. They cause distress. And I want to do something about it. This is why I feel enthusiastic about the philosophical approach of community psychology. But along all the abstract nouns, I miss the specifics. Perhaps it's because I am a trainee, and as such I am used to being shown how to do things, and I don't (yet) feel confident creating new ground. Or perhaps the sentiment that community psychology is easy to agree with and hard to do is common among other psychologists.

So here is a suggestion. Perhaps The Psychologist could offer Mr Anderson (or other community psychologists) a column where they could describe specific ways in which they worked towards their goals. A 'no-excuses, how-to guide' for aspiring community movers, if you will. Perhaps this could help me and others like me feel empowered to take our enthusiasm for social change away from the dinner party table and into the community – where it belongs.                                  

Mareike Suesse
Trainee clinical psychologist
Oxford Health NHS Foundation Trust

Editor's note: Thank you for the suggestion. We would certainly welcome further thoughts from  practising psychologists on how they convert ideological aspirations into positive action. We are planning soon to publish a special issue on austerity psychology that will deal with some of these issues and with wider implications of austerity. In the meantime we welcome more contributions to our Letters pages. 

It is very welcome to see The Psychologist, the monthly voice of members of the British Psychological Society, making a space for members of the Society to address critical issues raised by 'austerity' ('Austerity psychology', September 2013). After all, even the Chief Economist and Deputy Secretary-General of the Organization for Economic Cooperation and Development has conceded that 'austerity programmes…can add to the woes of already struggling economies, leading to more job losses and social hardship' and 'worsen' inequality, all of which are interconnected with the work of many members of the Society and, as the contributors point out, 'psychology has lagged behind other disciplines in trying to understand these connections', so this initiative is very welcome.

It is also welcome that the six responses from community and clinical psychologists, when asked whether 'these troubled times' have an impact on how Society members 'research, teach or practice psychology', responded by unambiguously positioning proximally preoccupied, individualistic, decontextualising, victim-blaming, oppressive, masculinist, neo-liberally managed enacted version of the discipline, i.e. the currently dominant versions, as thoroughly problematic.

It is also welcome that the six responses asked critical questions about whose interests are served by what is thought, written and done by psychologists and what the implications are of various positions taken up by psychologists for the empowerment of som and de-powerment of other interest groups.

What would be even more welcome would be more radical critique. The six responses: (i) problematically position 'austerity' as 'a psychological issue'; (ii) reinscribe the 'reality' of 'psychological states' such as 'distress', 'depression', 'anxiety', 'psychological ill-health' 'and other mental health problems'; (iii) position such psychological states as understandable and preventable through a psychological science of cause and effect; (iv) position 'power' as a phenomenon a psychologist can 'have' and that psychologists are able to redistribute through 'empowerment' ; (v) position austerity as an 'opportunity' to 'move psychology towards practising at a wider systems level', for the Society to, institutionally, give a 'strong professional lead', a stimulus to 'strengthen' psychologists' 'professional identity'; and (vi) position austerity as an 'opportunity' for psychologists to, individually, advance their sectional interests, conspicuously demonstrate principled solidarity and contest the new public management of psychology in practice.

In taking these positions, the responses problematically reinscribe a version of the psy complex ('the heterogeneous knowledges, forms of authority and practical techniques that constitute psychological expertise': Rose, 1999, p.vii) and thus underline the need to engage in critique of the frame of reference of the discipline rather than engage in critique within that frame of reference. In particular, although appearing to critique austerity and thus neoliberalism, in reproducing the psy-complex, the responses simultaneously reproduce the means of re-subjectification of citizens to render them self-managing within neoliberal forms of governmentality. That such re-subjectification has already been achieved in the case of some at least of the authors of these responses is already indicated by the suggestion that 'training in economic analysis' should be incorporated into 'research methods curriculum at undergraduate and post graduate levels' so they are 'not only…required to consider what works, but at what cost'. As Chris Lorenz (2012, p.603) has pointed out 'market fundamentalism is…the very core of neoliberalism' at the heart of the take-over of higher education by New Public Management.

David Fryer
Rose Stambe
University of Queensland
Brisbane

References
Lorenz, C. (2012). If you're so smart, why are you under surveillance? Universities, neoliberalism, and new public management. Critical Inquiry, 38(3), 599–629.
Rose, N. (1999). Governing the soul (2nd edn). New York: Free Association Books.

 

Anorexia and autism – a cautionary note

We read with interest Clare Allely's article (September, 2013) on the potential link between anorexia nervosa (AN) and autism spectrum disorder (ASD). Allely reviewed evidence suggesting an overlap between these two conditions both in terms of behaviour (e.g. interpersonal difficulties) and cognition (e.g. set-shifting and theory of mind difficulties), provocatively concluding that it seems 'reasonable to consider AN to be within the spectrum of autistic disorders'. While we warmly welcome discussion of the commonalities between these two conditions, we nevertheless believe that researchers should be more cautious in their analysis of the literature for two key reasons.

First, evidence not reviewed by Allely shows that atypicalities common across conditions (e.g.,' emotional theory of mind) are present largely during the active, rather than during the recovery, stage of AN (e.g. Oldershaw et al., 2010), suggesting that such atypicalities are likely to be a secondary consequence of starvation, not a fundamental feature of AN. These findings echo similar discussions almost two decades ago regarding the potential overlap between AN and another set of conditions, personality disorders (PD). Just like in the emerging AN–ASD literature, researchers in the 1990s reported signs of PDs (e.g. impulsivity, affective instability) in individuals with disordered eating – but, again, these features abated following recovery. Indeed, after a decade of research, the authors of one meta-analysis concluded that 'researchers and clinicians must exercise caution when assessing and diagnosing PDs during the active phase of an eating disorder' (Cassin & von Ranson, 2005, p.909). It would be wise for researchers and clinicians interested in the AN–ASD overlap to heed the same warning.

Second, one other key issue surrounding the debate over the overlap of ASD and AN was surprisingly absent from Allely's article – the suggestion that AN, which is primarily a disorder diagnosed in females, is a specific manifestation of ASD in girls and young women (Odent, 2010). In fact, AN has sometimes been referred to colloquially as the 'female Asperger's'. Consistent with this possibility, recent evidence suggests that females with AN are more likely to show elevated levels of autistic-like traits (Baron-Cohen et al., 2013). These findings make it tempting to conclude that there are common underlying cognitive and neural mechanisms in AN and ASD, as Alley suggests. Nevertheless, it also remains possible that AN and/or the starvation caused by AN may simply produce a phenocopy of autism.

Understanding the nature of the AN–ASD link is critical for understanding precisely how to intervene in both conditions. The eating disorder field offers decades of empirical evidence for the efficacy of a variety of interventions (e.g. Wade et al., 2011) that already work to target ASD-like characteristics such as rigid thinking. It will be important to understand the potential moderating influence of ASD-like traits on AN individuals' responses to such interventions. We believe, however, that the possibility that treatment approaches to AN could all benefit from a neuropsychiatric developmental disorder approach may well be an overstatement.

Rachel Hiller
Clinical PhD candidate
Flinders University, South Australia

Liz Pellicano
Director, Centre for Research in Autism and Education, Institute of Education

References
Baron-Cohen, S., Jaffa, T., Davies, S., et al. (2013). Do girls with anorexia nervosa have elevated autistic traits? Molecular Autism 4(1), 24.
Cassin, S.E. & von Ranson, K.M. (2005). Personality and eating disorders: A decade in review. Clinical Psychology Review, 25, 895–916.
Odent, M. (2010). Autism and anorexia nervosa. Medical Hypothesis, 75(1), 79–81.
Oldershaw, A., Hambrook, D., Tchanturia, K. et al. (2010). Emotional theory of mind and emotional awareness in recovered anorexia nervosa patients. Psychosomatic Medicine, 72(1), 73–79.
Wade, T.D., Treasure, J. & Schmidt, U. (2011). A case series evaluation of the Maudsley Model for treatment of adults with anorexia nervosa. European Eating Disorders Review, 19(5), 382–389. 

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Anabelle Denney
[email protected]

 

Educational psychology origins

I very much enjoyed the article by Leadbetter and Arnold 'A hundred years of applied psychology' (September 2013) outlining the history of educational psychology in Britain, but I take issue with them in their neglect of the part played by university departments of education. They correctly see that the arrival of universal education after 1870 resulted in schooling being the first area to which general psychology applied itself. However, the need to train teachers for the increasing numbers of pupils and schools promoted a science of education to be taught in the new Day Training Colleges opened from 1890 in UK universities, which later became their departments of education.

The article ignores this important development and it is possible to argue that the practice of educational psychology owes as much to the academic study of education as it does to psychology. Indeed, in the United Kingdom, before 1944 the majority of professors of education were psychologists. At the same time their universities were often indifferent to opening psychology departments. The impact of these professors on professional practice can be shown by naming a few of them: C.W. Valentine at Birmingham 1919–1946, Sir Godfrey Thomson at Newcastle 1920–1925 (later Edinburgh), Dame Olive Wheeler at Cardiff 1925–1951 and Cyril Burt at the London Institute of Education 1926–1932. Also at the London Institute was Susan Isaacs but never a professor. It is hardly surprising given the psychology taught in many education departments that some like Birmingham and Swansea became providers of training courses
in educational psychology.

Professor J.B. Thomas FBPsS
Loughborough University

 

Pain of work capacity assessment

I was pleased and inspired to read Dr Hayley Entwistle's letter ('Softening the impact of welfare change', September 2013). I read with interest previous letters on the subject of the welfare changes and how they impact our client groups (e.g. 'Can we be lobbyists for social change?' from Jade Weston and Nic Horley, April 2013). Like others, I believe that we should use our influence as health professionals to advocate for our clients. This is not to deny the point made in another letter that in some cases we see clients who twist the system to their own advantage ('Lobbying for social change', May 2013, name and address supplied). However, to get too much into this debate blurs the main issue, which is not about whether any one individual deserves welfare support but rather whether the system allows a fair assessment of their situation.

I work in a community chronic pain team, and for the last few years the topic of the Work Capacity Assessment (WCA) has dominated much of my clinical time. Since Atos were brought in to perform this assessment, many people who were previously deemed unfit to work due to a chronic pain condition have been told that they are capable of work and that they will lose their benefits if they do not comply. I have no problem with the stated logic behind the welfare reforms; however, the assessment system has to be fair and fit for purpose, and unfortunately this is not what we are seeing.

The WCA is inappropriate for people with long-term health conditions, where the amount that they can do varies considerably from day to day and where they experience 'pay back' (prolonged periods of increased pain or fatigue) if they push themselves beyond their current level of tolerance. I see at first hand the effects of the WCA. The shock, fear, anger and helplessness that my clients experience as a result of this process is hugely detrimental to the management of their health condition, and often it will undermine all the useful work they have done, or could have done, with pain management. It brings to mind Maslow's hierarchy of needs – if someone is focused on how they will keep a roof over their head and feed their family, then they are not going to be in a good place for psychological work. In some cases the financial, psychological and social fall-out is enough to tip clients into suicidal ideation and planning, or other self-defeating behaviours. Most of my clients end up going through a stressful and prolonged appeal and tribunal, and in many cases the original decision is eventually overturned and they are once again deemed unfit to work. It is infuriating to watch this process, and one wonders about the cost both in human terms and financially.

After being repeatedly confronted with this scenario, I got together with a group of colleagues to see whether there was anything we could do. We decided to approach the council of the British Pain Society and were refreshingly pleased to find that our concerns fell on open ears and a number of positive steps were taken. Dr Martin Johnson, Clinical Champion for Pain at the Royal College of General Practitioners, agreed to take the issue further via The Patients' Association. Dr Beverley Collett, said that she would raise it with the Chronic Pain Policy Coalition. A colleague and I were asked if we would write an article for Pain News, which we duly did (Jenkins & McGurk, 2012).

Our article produced some interesting responses, including a letter from a retired consultant who decided that he could make a positive contribution by sitting on the panel for the tribunal hearings thereby bringing a much needed specialist knowledge of chronic pain to a process which had hitherto neglected this. Perhaps this is something that psychologists might consider doing (if they are not already)?Recently the government commissioned a fourth independent review of the WCA system, to be led by Dr Paul Litchfield. The deadline for submissions to the review was 27 August 2013. The British Psychological Society attempted to coordinate a response, but unfortunately did not get enough of a comeback from members to make it worthwhile. I for one certainly did not see this consultation in time, and I suspect that others also missed it. My personal correspondence with the BPS Policy Team reveals that they are concerned that these consultations are not reaching enough members and they are currently developing new ways of distributing them. It is a shame that on this occasion we missed this chance to speak out and influence the shaping of what will hopefully be an improvement on the current situation.

Dr Rhona McGurk
Solent NHS Trust

Reference
Jenkins, A. & McGurk, R. (2012). What's the benefit? The impact of the overhaul to the benefits system on chronic pain patients – Should we be doing anything about it? Pain News, 10(4), 239–240.

 

Job market 'fundamentally broken'

Aspiring assistant psychologists, and job seekers generally, should take note of the feedback offered by Gavin Newby, Crawford Thomas and Beth Fisher (Letters, October 2013).

In my experience as a chronically underemployed psychology graduate, the points made by Newby and his colleagues reflect the views of very many recruiters, not just senior psychologists appointing staff. Unfortunately, these views reflect a failure to appreciate the circumstances in which graduates apply for jobs, as can be indicated by responding to the three major points made by Newby and his colleagues.

First, application forms with supporting documents can take many hours to complete. At the same time, there are pressures for the unemployed in particular to apply for large numbers of jobs. Moreover, if there are over two hundred applicants for a job, aspirant employees can be confident that they will be rejected. In these circumstances, it is unsurprising that people completing forms use generic techniques, such as 'cut and paste', and that they fail to check the quality of their applications adequately in terms of spelling and grammar.

Second, people invited for interview should of course have the courtesy to notify the panel if they are unable to attend. But the whole culture of the recruitment process has become one of non-communication. Employers routinely fail to let applicants, even ones who have completed lengthy and complex forms, know that they have been unsuccessful. By this standard, why should applicants tell employers that they no longer wish to be considered?

Third, once an applicant has got as far as an interview, it obviously makes sense to prepare by collecting information about the job. However, the time that candidates have to 'swat up' is often limited, particularly if they are lucky enough to have several interviews on consecutive days.

The problems that Newby and his colleagues report are symptomatic of a job market that is fundamentally broken. In other letters in the October 2013 issue of The Psychologist, both Lisa Molloy and Francis Harkness refer to the psychological harm done by over-competitive job seeking. Conversely, the plethora of job applications wastes huge amounts of recruiters' time, which would be better used to provide much needed services to clients.

Unfortunately, I am led from my career experience and the knowledge I gained from an MSc in occupational psychology to believe that the psychology profession is partly responsible for the inefficiency of current recruitment processes.

Government procedures originally developed, using advice from occupational psychologists, to protect the well-being of the unemployed have evolved, for political reasons, into coercive practices. In the private sector, there is excessive emphasis on advice to employers about recruitment and selection, rather than a balance between services for recruiters and for applicants.

Psychologists need to do more to improve the efficiency of recruitment procedures and to protect the well-being of job seekers. These aims are unlikely to be achieved unless the whole of the psychology profession provides a good example through its own practices.

Frederic Stansfield
Canterbury

 

Obituary:
Sheila M. Chown (1931–2013)

Sheila Chown (née Sawyer) was born in London and educate at Cheltenham Ladies' College. She entered Bedford College London to read psychology, achieving a first class degree in 1953. Following graduation, she worked for a year at Rowntrees in York before embarking on a PhD on the formation of occupational choice in grammar school pupils, the degree being awarded by the University of Liverpool in 1959.

From 1956 to 1960 she was employed as a scientific officer at the newly set up Medical Research Council Unit on Occupational Aspects of Ageing. This involved large-scale surveys of manual workers in the manufacturing industry on Merseyside and the administration of psychological test batteries to older people drawn from a variety of sources, including military hospitals, adult education classes and over-60s clubs. Sheila used to boast that she was one of the few people living who had carried out factor analyses 'by hand'. In 1961 a vacancy occurred in her alma mater and she joined the staff of the Psychology Department, where she was to remain for the rest of her academic career. She was appointed Reader in Psychology in the University of London in 1973.

Sheila's particular research interest was adaptation to change in relation to ageing. Highly cited articles in prestigious journals quickly established her reputation as an international expert on gerontology. This led to innumerable invitations to serve in an advisory capacity. In 1971 she was invited to the White House Conference on Ageing as a foreign observer, and hosted a meeting at Bedford College at which the British Society of Gerontology was founded.

Sheila was the bulwark of the Bedford College Psychology Department, lecturing mainly on social psychology, psychometrics and occupational psychology, and carrying a heavy administrative load with efficiency and good will. She particularly enjoyed postgraduate supervision, at which she excelled. Her students – many of them now established in senior positions across the globe – appreciated her support and guidance. Sheila was noted for returning their written
work with comments within 24 hours.

Outside the department, Sheila made a substantial contribution to the British Psychological Society from 1962 to 1980. Early success at conference organisation led to a series of offices: Treasurer 1965-67, Honorary General Secretary 1967-70 and Deputy President 1970-72. The opportunity for public service was important to her. For many years she served as a psychologist on selection boards for the Civil Service Commission assessing a wide range of candidates, work that she enjoyed and where her professional expertise, impartiality and discretion were highly valued.

Sheila was a generous and loyal friend with a strong sense of duty, conscientious in everything she undertook. She combined professionalism and efficiency with courtesy and kindness. An applied psychologist in the true sense of the word, her efforts were not confined to the ivory tower but contributed to the wider world in a number of different spheres. Many people – within and without academe – have cause to be grateful to her.

Elizabeth Valentine
Royal Holloway, University of London