Letters, September 2012

Throwing the soul out with the bathwater?

In his article 'Neuroscience for the soul' (July 2012), Craig Aaen-Stockdale provides a balanced critique of claims that activity in specific brain regions correlates with spiritual experience. As he argues, these claims are at best misguided, resting as they do on poor empirical foundations. The more fundamental question is whether a neuroscience for the soul is anything other than a straw man, with the consequence that a serious consideration of what the soul represents in psychological terms becomes lost in an avalanche of neuromania (Tallis, 2011).

All scholarly disciplines are founded on agreement regarding (i) the subject area of inquiry, (ii) the methodological approaches deemed legitimate to that inquiry, and (iii) the explanatory structures through which the knowledge base is advanced. In the case of the 'soul' the second and third criteria completely rule out neuroscience as being of relevance. The soul is known (if at all) through methods of contemplation and meditation; and is 'explained' through explanatory structures having little, if any, relation to physicalism. Given that the methodology and explanatory framework of neuroscience are totally bound to physicalism, there can be no neuroscience for the soul. Were this all there was to the matter, we could happily leave soul-speak to priests and theologians.

Confusion arises, however, on account of the first criterion; according to traditional conceptions, the soul clearly has some connection with the mind, and it therefore sits within the discourse of psychology. Most religious traditions, for example, identify intellectual functions with the soul. Indeed, whatever its spiritual connotations, the term 'soul' should be understood as referring to aspects of the psyche that are not addressable by the methods of neuroscience. Whether such aspects are ontologically separate from the physical realm or simply inaccessible by contemporary methods is a question on which endless speculation may ensue. But the issue for psychology is more pragmatic: should the discipline include these aspects of the psyche in its discourse? Is it psychologically useful to explore the 'soul'? As a transpersonal psychologist, I answer 'yes' to this question for reasons such as the inadequacy of physicalist theories of consciousness; the value for human well-being of practices and systems of thought associated with religion; and insights from spiritual and mystical traditions concerning transformation to more fulfilling states of being, etc. Whether or not we can provide any physical evidence for the existence of the soul should not dictate our recognition as psychologists of the term's value.

The real culprit here is overemphasis on anomalous experience as the core element of religion. Of course, in a trivial sense all religious activity involves experience of one kind or another. But, contra Aaen-Stockdale, it is not the exceptional experiences of religious leaders that matters. The experiences of the initiators of religions are often lost in the twists and turns of polemical writings and commentary; it is their insights into the human condition that inspires their disciples, and offers a legitimate subject for psychological study.
Brian L. Lancaster
Chair, BPS Transpersonal Psychology Section
Emeritus Professor of Transpersonal Psychology
Liverpool John Moores University
 
Reference
Tallis, R. (2011). Aping mankind: Neuromania, Darwinitis and the misrepresentation of humanity. Durham: Acumen.

John Rowan's strongly worded attack (Letters, August 2012) on my article 'Neuroscience for the soul' argues that I 'exhibit considerable ignorance' or am 'clearly prejudiced' regarding matters of the soul, but in it he demonstrates not a little ignorance and prejudice on his own part.

For example, he seems to be ignorant of that fact that the argument from personal experience holds little weight in the scientific arena. Giving him the benefit of the doubt for the moment, I will accept his claim that mystical experiences may 'be very much like a psychedelic trip' and try to explain why I believe that this doesn't 'actually tell us anything about religion'. That something is 'like' something else does not mean it is the same or shares the same substrate or causes. A mushroom cloud is 'like' a mushroom in form only, not in substance, and certainly not in cause.

The second prong of his argument, that drug-induced epiphanies are looked back on favourably months or years after the event, is irrelevant. Why on earth would generations of humans continue to (ab)use various substances if they didn't produce extraordinary and sometimes moving experiences? What is currently missing from the neurotheological narrative is anything actually linking these drug-induced experiences to religion or spirituality except a surface similarity. This is simply not good enough for a field with scientific pretensions. While I and other researchers are attempting to establish (or disprove) some genuine connection, it would be nice if we weren't constantly lambasted by those who seem happy to interpret these 'anecdata' in accordance with their own prejudice.

By the way, it has been pointed out to me that in my original article (at the top of p.522) I wrote 'millitesla' when I meant 'microtesla'. How embarrassing! The comparison with a fridge magnet, etc. and the conclusions I draw are nevertheless still valid. My apologies.
Craig Aaen-Stockdale
Buskerud University College
Kongsberg, Norway 

The stigma of ill health

When studying the relationship between society and health, it can be concluded that social integration and cohesion can influence mortality (Durkheim, 1897/1951). Indeed, it is now widely recognised that social relationships and affiliations can impact upon the physical health, cognitive and emotional states of patients.

The manifestation of ß-thalassaemia, a genetic disorder of haemoglobin, has burdensome clinical symptoms and treatment and therefore challenges the individual on a psychosocial level, especially in the adolescence stage when the teenager is confronted with various difficulties like identity formation, developing intimate relationships and entering the working world (Khurana et al., 2006). Accepting and integrating thalassaemia into one's identity becomes a difficult task. For many years the presence of thalassaemia was identified with, and often still is considered a stigma, a source of inferiority (Georganda, 1990). The affected individual is not seen as a person with a physical problem but as a weak, different, inadequate, incapable being for whom we feel sorry and to whom we offer our sympathy. Thus what is incorporated in one's self-image is not only the physical illness but also a specific view and a specific attitude towards one's self: the internalised image of an inferior individual (Georganda, 1990).

Facial characteristics in thalassaemia occur as a consequence of the expansion of bones, particularly the skull and jawbones, and anaemia and iron overload in these patients often leads to short stature and delayed puberty. Consequently, they are likely to suffer from reduced self-esteem, poor self-image, increased dependence and anxiety over issues such as pain and death. Ratip et al. (1995) stated that the most common cause of death in thalassaemia is psychosocial
in nature in Western countries.

Clearly, realistic hardships present themselves to individuals that have a chronic physical illness, including how society views and treats them. Maintaining adequate social support may be problematic for some people with ß-thalassaemia due to the stigma associated with the disease among other persons in one's support network. Stigma was often associated with perceived 'blemishes of individual character' (Goffman, 1963). As individuals experience chronic illness there is potential for disruption to their social support system that may inadvertently affect their quality of life (Bush et al., 1998). The stigma of having a chronic illness may impact upon an individual's self-concept, capacity to adapt to the chronic illness and the quality and quantity of social networks (Millen & Walker, 2001). One may speculate that patients see social support as a mirror image of social stigma, and the quality and quantity of social networks become evidence of social rejection. A lack of social support may thus signify a diminished self-value; and less instrumental cognitive and emotional support from fewer resources in turn lessens patients' opinion with regard to their ability to cope with the disease (Amir et al., 1999).

It is important that healthcare providers understand how patients cope with stigmatising genetic conditions in order to deliver comprehensive care. Resulting discrimination seems to discourage individuals from getting the psychosocial support they need from services to the extent that individuals are at risk of mental illness (Jenerette et al., 2006). In developed countries, the combination of appropriate medical care and the psychosocial support provided to patients has led to greatly enhanced survival and a good level of social integration, social acceptance and favourable self-esteem (Politis et al., 1990). Based upon the issues surrounding the stigmatisation and social integration of ß-thalassaemia patients, is there scope to undertake further programmes of research and the role of stigma within the illness?

Xenya Kantaris
Faculty of Health and Social Care Sciences
Kingston University

References
Amir, M., Roziner, I., Knoll, A. & Neufeld, M.Y. (1999). Self-efficacy and social support as mediators in the relation between disease severity and quality of life in patients with epilepsy. Epilepsia, 40, 216–224.
Bush, S., Mandel, F.S. & Giardina, P.J. (1998). Future orientation and life expectations of adolescents and young adults with thalassemia major. Annals of the New York Academy of Sciences, 850, 361–369.
Durkheim, E. (1951). Suicide: A study in sociology (Trans. J.A. Spaulding & G. Simpson). New York: Free Press. (Original work published 1897)
Georganda, E.T. (1990). The impact of thalassemia on body image, self-image, and self-esteem. Annals of the New York Academy of Sciences, 612, 466–472.
Goffman, E. (1963). Stigma. London: Penguin.
Jenerette, C., Funk, M. & Murdaugh, C. (2006). Sickle cell disease: A stigmatising condition that may lead to depression. Issues in Mental Health Nursing, 26, 1081–1101.
Khurana, A., Katyal, S. & Marwaha, R.K. (2006). Psychosocial burden in thalassemia. Indian Journal of Pediatrics, 73, 31–34.
Millen, N. & Walker, C. (2001). Overcoming the stigma of chronic illness: Strategies for normalisation of a 'spoiled identity'. Health Sociology Review, 10, 89–97.
Politis, C., DiPalma, A., Fisfis, M. et al. (1990). Social integration of the older thalassaemic patient. Archives of Disease in Childhood, 65, 984–986.
Ratip, S., Skuse, D., Porter, J. et al. (1995). Psychosocial and clinical burden of thalassaemia intermedia and its implications for prenatal diagnosis. Archives of Disease in Childhood, 72(5), 408–412.

International assistance

Along with a few other professional volunteers, I am working towards assessing the psychological needs of Syrian children and youth in the refugee camps in Turkey, to ensure their psychological well-being and know the kind of help to make available to them.

As you may know, the Syrian refugees in Turkey fled Syria to evade gunfire and bombings, and most of their homes were destroyed; many have lost friends and family and many children have been orphaned. Some of the refugees have been in Turkey for over 12 months; and while the Turkish government, the United Nations and several NGOs have helped facilitate their stay, the experience of traumatic events during their time in Syria, fleeing to Turkey and residing as refugees while conflict is taking place in their homeland is thought to have brought about mental health problems.

Limited mental health support has been offered to the Syrian refugees, especially children and youth who may be experiencing post-traumatic stress disorder, depression, anxiety as well as other common mental health problems. It is vital to make available psychological support to not only prevent severe mental health problems, but to ensure that young people have the necessary coping skills to deal with their situation during and after their time at the refugee camps; encouraging healthy child and youth development.

Contacts have been established in the refugee camps, and three British mental health facilitators (including myself) are volunteering their time to work on this meaningful project, as well two clinical psychologists in Turkey. The Child and War Foundation has extended its support on the project, and has put us in contact with the clinical psychologists in Turkey (one of whom works in the Turkish Red Crescent). The Foundation has validated and translated instruments to measure trauma and other mental health problems and has produced a manual to use in providing coping skills for the children in the refugee camps. It has also offered to provide training on these techniques using the manual for our volunteers.

We are still fundraising for the project, and hope to be able to get funds to cover the flights and accommodation for volunteers.

More mental health facilitators are needed to volunteer their time to visit the refugee camps to make this project a success; they need to speak Arabic. What's more, expertise on venturing this major project before and after visits to Turkey is much needed (experts do not have to speak Arabic); as well as funding to cover basic expenses for volunteers visiting the refugee camps to offer mental health support like flights and accommodation.

The Syrian people are calling for our help I hope we can answer. Please get in touch with me.
Masa Al-kurdi
[email protected]

The UK-Sri Lanka Trauma Group (UKSLTG) was founded in 1996 by a group of Sri Lankan expatriate and British mental health professionals concerned at the escalating civil conflict in Sri Lanka and its psychological impact. The group has been responsible for setting up a Sri Lanka-based organisation, Samutthãna, which functions as a resource centre for mental health capacity building and facilitates the work of volunteers from within Sri Lanka and overseas who wish to contribute and participate in training.

Members of the UKSLTG provide pro bono high-quality training in coping with traumatic events and mental health issues resulting from the 26-year civil war and the 2004 tsunami in Sri Lanka. Using a network of trainers (mainly based in the UK but with Sri Lanka heritage or other links), it has responded to a demand for high-quality workshops covering how to work with people traumatised by war, torture, loss of home and community, death of loved ones and imprisonment in displacement camps. In addition the UKSLTG runs a range of workshops on more general topics such as addiction, working with children and families, loss and bereavement, to name but a few. The training and capacity-building activities are run at three levels so that Sri Lankan volunteers, as well as individuals with some training and mental health professionals, can benefit from programmes.

With only one psychiatrist for every 120,000 people and only a handful of psychologists, mental health is not yet able to be prioritised to the degree that it might be. That is why Samutthãna is focusing on supporting the development of more holistic and less medicalised services that promote recovery, and that people can access in the community. The vision is that more people with mental health problems can take part in society and fulfil their potential.

The UKSLTG is looking for experienced BPS chartered and HPC registered psychologists who are able to volunteer at least three or four months of their time to working in Sri Lanka. Enquires from people with links to Sri Lanka are encouraged to apply, although this is not essential. Our team based in the UK and Sri Lanka can provide orientation and support in advance of your trip and whilst you are in Sri Lanka. Clinical supervision will also be available via Skype. Volunteers have to be self-funding as the UKSLTG has no funding to cover flights and accommodation, but we are happy to assist with arranging these. If you would like further details please contact us at the e-mail address below.

The UKSLTG is also running a seminar series throughout 2012 on renewal and reconciliation in post-war countries. Details can be found on www.uksrilankatrauma.org.uk and our Facebook page.

Rachel Tribe
University of East London
[email protected]

Degree that never was

I have just finished my undergraduate degree in psychology at Bournemouth University. When opening my final transcript I was delighted to find that I had attained a first. The feelings of elation were uncontrollable, but at the same time I realised that, by current standards, I shouldn't be awarded this degree. The 2013 entry requirements for Bournemouth are set at B-B-B. In my A-levels, I managed B-C-C-D. This made me question the usefulness A-level grades as a predictor of success at university? Shouldn't psychology be the discipline to 'break-the-mould' on entry requirements?

 I had this conversation with a senior lecturer at Bournemouth. He revealed that at A-level he was only interested in 'the two Gs':the Gym and Girls. I can empathise with this, I lacked motivation and drive for academic pursuits at college. I believe that in this respect, I am not alone. I have other friends who achieved far lower A-level grades than me yet still accomplished upper second class degrees at various institutions and in various disciplines. In light of this, I believe that A-level accomplishments are neither valid nor useful as a measure by which universities should decide who is able to enrol on their courses. Furthermore, how many students are being wrongfully barred from university because of poor performance at college?

It is most likely obvious to most, but I did not realise until reaching university how entry requirements were set. For those who don't know, it is a calculation based on demand and supply. The more people that apply for a course, the higher the entry requirements are pushed as a method of limiting applications until the desired cohort size is reached. This filtration method, combined with the increasing popularity of psychology as an undergraduate degree, may worsen the current problem. As more people apply for psychology degrees, this will surely push the entry requirements ever further.

What is the alternative to A-level grades? The obvious is the infamous IQ test. However, does the IQ tap the demands that will be required in a psychology degree? To succeed in psychology, I would argue that a student requires a basic understanding of mathematics, a critical approach to literature and drive. Surely mathematics and critical thinking can be measured easily enough via a short written assessment, perhaps administered online.

The goal of my self-indulgent ramblings is to provoke thought about the way in which universities accept and decline a student's application. As the aforementioned senior lecturer once said, 'A-levels reflect the person you were and not the person you are now.' I'd like
to add a little more to this, A-levels do not reflect the person that you can become. This kind of change can only come from psychology, and I feel that we have a responsibility
at least to question the current system.

Ben Hunt
East Meon
Hampshire

FORUM guest column: Survival guide
The costs of doing different types of psychology vary hugely. If you just want to see how people remember different types of material, for instance, or test children's understanding of numerosity, this can be done with very little money. In contrast, most kinds of brain imaging require not only expensive equipment, but also a building to house it and staff to maintain it. Furthermore, data analysis can take weeks, or even months, rather than hours.

In academic research, money follows money through the QR allocation. This makes sense: an institution that is doing costly research needs funding to support the infrastructure for that research. The problem is that grant income, rather than the research, has become the indicator of success. Hiring committees will scrutinise CVs for evidence of ability to bring in large grants. Universities, after all, have to survive in a tough financial climate, and so we are all exhorted to go after large grants to help shore up our institution's income. This means that cheap, cost-effective research in traditional psychological areas will be devalued relative to more expensive neuroimaging.

I have no quarrel with psychologists doing neuroimaging studies, and it is important that if good science is to be done in this area it should be properly funded. I am uneasy, though, about this unintended consequence of the enthusiasm for neuroscience. I've been reading Daniel Kahneman's Thinking Fast and Slow, a highly influential book by a psychologist who has the rare distinction of being a Nobel Laureate. I couldn't help thinking that Kahneman would not fare well in the current academic climate, because his elegant, simple experiments were just too inexpensive.

I believe that systems of academic rewards need to be rejigged to take into account not just research income and publication outputs, but the relationship between the two. Of course, some kinds of research require big bucks, but large-scale grants are not always cost-effective. And on the other side of the coin, there are people who do excellent, influential work on a small budget.

I thought I'd see if I could get some hard data on how this works in practice. I looked at data for psychology departments from the 2008 Research Assessment Exercise (RAE). This gives information on grant income, and I also used Web of Science to compute an
H-index based on publications for each department. The details can be found on my blog: tinyurl.com/deevybee.

Not surprisingly, I found that research income and H-index
were predictive of a department's RAE average score: together they accounted for 80 per cent of the variance. There was, however, a wide spread in H-index for those institutions with the highest levels of grant income. Some were clearly using their substantial income to do influential work, but others seemed to achieve no more than other departments with much less funding. There may be reasonable explanations for this – for instance, a large tranche of funding may have been awarded in the RAE period but not had time to percolate through to publications. But there's still the worrying possibility that we may be rewarding those who chase big grants without paying sufficient attention to what they do with the funding.

It would be nice to see some kind of indicator of cost-effectiveness included in ratings of departments alongside the more traditional metrics. In times of financial stringency, it is particularly short-sighted to discount the contribution of researchers who do influential work with relatively scant resources. 

Dorothy Bishop is Professor of Developmental Neuropsychology at the University of Oxford. Read the full version of this column at http://deevybee.blogspot.com. This column aims to prompt debate surrounding surviving and thriving in academia and research.

Why environmental psychology is neglected

Global climate change and other environmental issues threaten the very existence of the human species. Yet, as Paul Hanna points out (Letters, August 2012), psychologists have failed to deal adequately with these vital problems. However, the root causes why environmental psychology is neglected stem from political and organisational issues.

Firstly, psychology in the United Kingdom is compartmentalised by the government, not least through statutory registration, as a health-related profession, with health as the 'lead' department. The result has been an over-concentration on subdisciplines such as clinical psychology. The list of Divisions of the American Psychological Association shows a number of areas of psychology, including environmental psychology, that are comparatively neglected by the British Psychological Society.

Many years ago, government interest in psychology was led by powerful Departments such as Defence and its predecessors. This led to leading psychologists, including Sir Frederic Bartlett and Donald Broadbent, doing important research on environmental issues, for instance the effects of noise.

A second reason why environmental psychology is overlooked arises from the funding policies of Research Councils. In recent years, British investment for several subdisciplines in psychology has been concentrated on single university departments, such as Sheffield for occupational psychology, Exeter for economic psychology and Surrey for environmental psychology. These departments all have world-class reputations. They need more investment, not less. However, the government funding strategy is inadequate. The amount of research that can be carried out in even a large university department is limited.

Academic advance is limited by a lack of diverse institutional perspectives. And, as Hanna has noticed, the findings of subdisciplines such as environmental psychology fail to reach undergraduates  in the many universities that are not research-active in the area.

A third problem is that too many subdisciplines have been lost by psychology to more powerful academic subjects. Hanna points out the dominance of market research in relation to consumer behaviour. Economic psychology has become dominated by what economists call behavioural economics. Environmental psychology is overshadowed by disciplines relating to the built environment, particularly architecture.

The British Psychology Society needs to re-establish the position of psychology as a basic intellectual subject, not a technical discipline relating to health matters. We then need to lobby for organisational and funding arrangements that will enable psychology to be applied wherever it is relevant to human life.

Frederic Stansfield

Two letters in The Psychologist segue neatly (August 2012). The first points out that human actions contributing to climate problems are given far too low a priority in psychological research, the second that our survival as psychologists depends on our ability to translate research into action. Indeed, my recent literature search into practical psychological advice towards behaviour changes for the benefit of the climate found theories and research, but thin pickings on what to do about it. I had to dig into earlier work such as Kurt Lewin's, and the more recent anti-smoking campaign, to show how behaviour can be changed. The ecologists have presented their frightening evidence, but without practicable contributions from our discipline that may all be in vain. And if we can't do it, who can?
Professor Joan Freeman
London W1

I was very pleased to read Dr Paul Hanna's letter on psychologists and the environment ('Engaging with the environmental crisis', August 2012.) The ethics that I was taught as a student protected the client and other vulnerable people, such as children who may be being abused, and upheld the standing of the profession. They also made reference to wider public interest. The discussions I have heard since then have continued in a similar vein.

As clinician, however,  I ask myself the sort of questions that were not addressed in my universities and have only been rarely mentioned since.

I would not encourage clients to smoke tobacco because it would be injurious to their health. Should I ever mention the fact that driving a car may be injurious to others by contributing to asthma?
If a client were to tell me that he/she is planning a murder or act of terrorism I would take immediate action. But, what if the client takes unnecessary long-haul flights that will affect the earth's climate and the lives of millions?

I would not encourage a client to engage in sex-tourism. But what if the same client was planning a holiday that will exploit the poor or damage the local environment? Should I ever confront the client with the possible consequences of his/her actions?

I do not want psychologists to become social engineers. Nor do I want us to have a code of legalisms, even if they are well intentioned. The environmental crisis however is real and will affect us all. We need ethics, research and a professional ethos to help us meet the challenge.
John Steley
London E17
Canterbury

 

Delivering primary care psychological services

We have followed with interest the recent correspondence concerning psychological services and general well-being. Bhupinder Kuwar (Letters, July 2012) raises some important considerations, the most pertinent being 'Maybe we need to consider further alternatives'. The APA Monitor article ('Beyond psychotherapy') to which Kuwar provides a link is indeed an excellent place to start.

However, we feel it is worth highlighting that the Glasgow STEPS Team has for several years been implementing a high-volume, well-being-focused primary care mental health service, offering not just individual psychological therapy but a wide range of matched-care alternatives… and, indeed, was featured in The Psychologist as long ago as October 2008 ('Stepping up primary care'), including on the cover.

If readers are interested in finding out more, we would direct them to White (2010), or get in touch directly via 'Feedback' at www.glasgowsteps.com.
Simon Stuart
Jim White
STEPS Team, Glasgow
 
Reference
White, J. (2010). The STEPS model. In J. Bennett-Levy et al. (Eds.) The Oxford guide to low intensity CBT interventions (pp.35–52). Oxford: Oxford University Press.

For the complete Letters section, please view PDF version .