Reviews, May 2013

Moving and inspiring                                                                       
Death of a Soldier: A Mother's Story
Margaret Evison

Dr Margaret Evison is a consultant clinical psychologist specialising in palliative care. She is also a mother with two children; a daughter, Elizabeth, and a son, Mark. This book is about the death of Margaret's son.

Lieutenant Mark Lawrence Evison, 1st Battalion Welsh Guards, died of his wounds in Selly Oak Hospital, Birmingham on 23 May 2009 having been wounded in action at Haji-Alem, Helmand Province, Afghanistan on 9 May 2009 and aeromedically evacuated from the military hospital at Camp Bastion to Birmingham the following day. Lt Evison had been an officer in the British Army for less that 18 months, in Afghanistan on his first tour of duty there for less than a month and, with his platoon, in the turreted fort patrol base of Haji-Alem for just over two weeks.

By all accounts, Mark Evison was an exceptional young officer, rated by his soldiers, peers and superiors as one of the most capable young officers in the battalion, and destined for great things. His mother describes him as a caring, compassionate, charming, able and handsome young man and his death, like all deaths, was a tragedy.But Mark Evison's death was more than a tragedy. It was the result of a complex web of circumstances involving the timing of medical evacuation helicopter flights, the contents of field medical packs and the adequacy of radios. It was the latter that caused Lt Evison to step out of cover, perhaps to get a better signal, when he was hit by the fatal shot to his shoulder from a sniper's bullet, the second that may or may not have aided a speedy stabilisation of his wounds and the former that may have affected transporting Mark Evison back to hospital at Bastion within the 'golden hour' deemed necessary to maximise his chances of survival.

Death of a Soldier is the collage of hospital notes, entries from Mark's journal, reports from superiors, letters, SIB reports1 and transcripts of the inquest into his death that was assembled by Margaret as she tried, in a relentless quest, to try to piece together the jigsaw of complexities and tragedy surrounding the circumstances of his fatal wounding, his evacuation by helicopter across the dusty plains of Afghanistan and onwards in three aircraft from Afghanistan to Birmingham and his subsequent care and death in Selly Oak. Death of a Soldier is an account of 'a dying observed', with all the events that led up to his eventual death in hospital viewed mostly in retrospect, sometimes second- or third-hand (although Channel 4, with Dr Evison's permission, showed the helmet-camera footage of the battle in which he was shot in October 2010). In this book, the author's grief is not observed in the way that the grief of C.S. Lewis was2 but is nonetheless so apparent in every page that this courageous and hugely impressive psychologist has written about the death of her beloved son. She writes: I would not have believed that the pain of a child's death could be so wracking, so complete. It is the breaking up of intense biological bonds built to nurture and endure, it is a shattering of what was intended. One knows of nature's anger with the unnatural splitting of an atom: so a parent feels a child's death.

I was moved and inspired by this book, and think that you will be too.

1 The SIB is the Army's equivalent of the CID, the Special Investigation Bureau.
2 In A Grief Observed (1961) C.S. Lewis reflects on his experience of bereavement following the death of his wife.

Biteback Publishing; 2012; Hb £16.99
Reviewed by Jamie Hacker Hughes who is an Independent Mental Healthcare Consultant and Visiting Professor, Anglia Ruskin University

A consuming read
Food and Addiction:
A Comprehensive Handbook
Kelly Brownell & Mark Gold
Against a global backdrop of widespread obesity, Food and Addiction takes a clear stance that addiction to food is as real as any other addiction. Libertarians will shudder at some points; discussion of how people are to control portion size in particular comes off as patronising. On the other hand, much of the ideas at work here give the reader a practical sense of how one's own consumption could be better controlled (e.g. by choosing less energy-dense food), and the book tackles the controversial topic of food addiction with perspectives from psychology, physiology, public health and other disciplines.

The short length of the chapters and the two-columns-a-page layout give this book a page-turning quality. Nonetheless, the book as a whole has a measured pace; the first two sections cover addiction and feeding in depth, before the two topics are brought together for the remainder.

There's no shortage of self-help books on food addiction, often written from a perspective of personal recovery. Want a broader empirical look at food and addiction? Add this to your bookshelf.

Oxford University Press; 2012; Hb £75.00
Reviewed by Andrew P. Allen a postdoctoral researcher at University College Cork 

Opening a window on adolescence
Brainstorm
Islington Community Theatre

Adolescence is the period of life during which we start to figure out who we want to be. It is a time of increasing capacity to make sense of the world and the people in it. It is a time of discovery, coincidence, immense passion and, of course, profound self-consciousness, embarrassment and conflict. The teens behind the production Brainstorm are not only able to recreate the tumultuous – albeit oft-misunderstood - world of adolescence on stage, but also bring the audience into this world by opening windows onto the mind. The play begins with its entire cast on stage as one teenaged girl begins to tell a story about someone she knew who died while riding a bicycle. Although the story begins as a monologue, multiple voices chime in at times derailing the story into tangents on pop stars, memories and parental aspirations, before returning back to the main thread. This opening scene, at once chaotic and fluid, feels like peering into one teenager's stream of consciousness.

As the opening scene fades, a projection screen plays a video montage of various scientists describing the still-developing teenage brain, interlaced with shots of teens alone in rooms singing songs, skateboarding down stairs and other stereotypical behaviours described by the scientists. This opening video appears to confirm just what adults have always suspected – that their teenagers' behaviour is biologically based in the brain and what we can expect from teens is immature, reckless behaviour.

However, the play itself explores this relationship between the teenage brain and behaviour by taking the stereotypes down to the individual level. At times it feels like a beautifully constructed public service announcement for adults; one meant to remind them of the complexities of teenagers' lives and brains. The production carefully weaves in scientific evidence to support their message that the adolescent brain is not simply an immature adult brain, but that the teen brain it is different from the adult brain. The performance reminds us that teenagers and their brains harbour remarkable potential to change the world because of these differences.

Many scenes of the play involve communicating with parents, often around conflicts involving personal and parental aspirations. The scenes are interspersed with poetry, alluding to the teen brain as visiting a new city where one has not yet figured out the shortcuts. At one point the audience is treated to a real-time 'brain scan' where the actors anonymously respond to  statements projected onstage by lighting a representative lamp via remote. Each statement is more provocative and illuminating than the last, ranging from 'I want to be a lawyer' (no lamps light up) to 'I am in love with someone on this stage' (half the lamps light up).

Islington Community Theatre (www.islingtoncommunitytheatre.com) works with young people from across the entire second decade (ages 9–21 years) in close collaboration to create and perform professional-quality theatre performances. I had the great opportunity to witness one of the first rehearsals of this show, and was immediately struck by the level of control the young actors had on the production. The directors, Ned Glasier and Emily Lim, have an impressive ability to draw a story from each of a dozen voices, and facilitate the development of those stories rather than impose an already structured narrative. This is likely one of the reasons the production was so powerful at the same time as feeling authentic. Given that adolescence is a time in which heightened self-consciousness can make going out in public with a family member seem like torture, witnessing such bare openness was at times overwhelming.

Reviewed by Kate Mills and Sarah-Jayne Blakemore, University College London

 

A fascinating skirmish
BishopBlog
Dorothy Bishop

Readers of this publication may well be familiar with Professor Dorothy Bishop, the academic, blogger and all-round good egg. We interviewed her in the January issue (see tinyurl.com/bsz44rr), just after she had won runner-up in the inaugural UK Science Blog Prize for http://deevybee.blogspot.co.uk. She is also building up quite a following on Twitter (@deevybee), which has been abuzz lately with discussion of her musings.

For those of you unfamiliar with blogging as a form of communication, this is no personal brain dump full of pictures of cats and word searches. Bishop says what others might be thinking, skewering one issue after another in a series of practical and thought-provoking posts. At the time of writing, there's an excellent piece on 'Ten things that can sink a grant proposal' which includes sage advice such as: 'An overoptimistic proposal assumes that results will turn out in line with prediction and has no fall-back position if they don't. A proposal should tell us something useful even if the exciting predictions don't work out. You should avoid multi-stage experiments where the whole enterprise would be rendered worthless if the first experiment failed.'

But the main attraction in March was an exchange between Bishop and the authors of a paper she had criticised, on video games and dyslexia. The study, by Sandro Franceschini and colleagues and published in Current Biology, had just 10 participants per group and Bishop thought this underpowered. Two of the authors, Andrea Facoetti and Simone Gori, replied on Bishop's blog that many other studies have used equally small samples. 'This is undoubtedly true,' Bishop said, 'but it doesn't make it right'. Bishop to Queen 4, Check.

The study authors also commented that 'bashing other people's work without any collected data that prove or at least support that claims [sic] seemed to us really unfair, honestly', saying that 'the suited arena for a scientific discussion should be the peer reviewed international journals'. This led Bishop to share her thoughts on so-called 'post publication peer review'. In her opinion, 'journal editors should have recognised this as a pilot study and asked the authors to do a more extensive replication, rather than dashing into print on the basis of such slender evidence'. As for whether a blog is the appropriate forum for such discussion, Bishop wrote: 'I don't enjoy criticising colleagues, but I feel that it is entirely proper for me to put my opinion out in the public domain, so that this broader readership can hear a different perspective from those put out in the press releases. And the value of blogging is that it does allow for immediate reaction, both positive and negative.'

Judging from the wider reaction to her blogging, she has plenty of support for that view.

Reviewed by Dr Jon Sutton who is Managing Editor of The Psychologist

Making interventions work in educationHandbook of Implementation Science for Psychology in Education
Barbara Kelly & Daniel F. Perkins (Eds.)
This book aims to explore and explain what makes psychological interventions work and how to enhance the impact in natural educational contexts characterised by the lack of experimental control.

It pulls together the epistemological, methodological and theoretical aspects of implementation science, covering various practitioners' frameworks and approaches, specific interventional methodologies and programmes in the key areas derived from educational and psychological theory and research.

What is really interesting and innovative about this book is that it makes headway in clarifying concepts of implementation science, defining its overall readiness in terms of resources, skills, effective delivery and evaluation, concerning an unbalanced account of awareness and practice in the current evidence-based programmes, and suggesting professional roles such as interventionist field specialists.

This book is different from other intervention-related books in several aspects. It does not solely tackle the 'classical' barriers to effectiveness (such as accessibility, variability and unpredictability). It equally demonstrates the emergence of successful, constructive evidence-based implementations developed by rigorous, alternative protocols that are complementary of traditional paradigms. It explores implementation frameworks in a range of educational contexts; some are from a wide lens and others have narrow focuses. It underlines the subtleness and complexity of developing implementations, and critically demands systematic, analytical approaches to evaluating effectiveness in a dynamic ecology of education with the purpose of fostering a shared vision in psychology and education.

I would recommend this book as a useful resource for those who are involved in understanding, designing, delivering, measuring and improving interventions in real-world educational contexts.

Cambridge University Press; 2012; Hb £90.00
Reviewed by Qing Wang who is a doctoral researcher in educational psychology at the University of Bristol

 

Ethical treatment                                                                               
Side Effects                                                                                          
Steven Soderbergh

This captivating film is apparently director Steven Soderbergh's last and stars Jude Law as Dr Banks, the current psychiatrist of patient Emily Taylor (Rooney Mara). After Banks asks Taylor's former psychiatrist (Catherine Zeta-Jones) for advice he sets off a chilling chain of events.

Psychiatric drugs are the keystone of this film, as the title suggests, with various aspects of the psychiatric and psychological milieu cleverly coming in and out of focus throughout. The relationship between a psychiatrist and their client, the free will of the patient and the ethical issues surrounding the behaviour of large pharmaceutical companies all feature, resulting in the occasional feeling that you are watching a number of different films at once. That is, however, until the final act when Soderbergh expertly brings everything together. This film is both a psychological thriller and a court-room drama, with a couple of scenes of a sexual nature thrown in for good measure.

Jude Law's character comments on the difference between America and the UK with regard to treatments for mental health disorders and their associated stigma. This may be of particular interest to readers of The Psychologist; however, these comments and the many representations of various issues relating to mental health are sure to result in some interesting post-film conversations for lay people, experts and all in between. Rooney Mara's portrayal of someone experiencing severe depression should have you on the edge of your seat during the film, and keep you talking afterwards. Hers is not the only depiction of a life spiralling downwards, and this film is one of Jude Law's best.

Those familiar with the themes should not assume this will be a bore; the beauty of this film is that you will want to watch it again.

Reviewed by Charlie Lea who is a PhD Student at Royal Holloway, University of London 

 

Psychological understanding of design
Designs of the Year Awards
Design Museum, London

Described as 'the Oscars of the design world', London's Design Museum (http://designmuseum.org) has currently devoted a floor to this annual Design of the Year Awards. International designs from seven categories have been nominated: architecture, digital, fashion, furniture, graphics, transport and product. 

The event has been curated to mix the categories together, giving a pleasing hodge-podge of designs from different areas. The exhibition showcases high-brow couture alongside everyday design, such as the non-stick ketchup bottle. Attractive graphic designs include the covers of Ralph Ellison's books designed in the jazz-era style, and Adam Thurlwell's book written with type-faces running in all different directions, and with pull-out sections in amongst the book to emphasise the chaotic nature of the story.

Two exhibits stood out to me from a health psychology perspective. The first was an app which aims to encourage exercise by making it more fun to run. The 'Zombies, Run!' app creates an interactive running experience. This is a personalised gaming environment which combines music from your playlists on your smartphone with voiceovers and sound effects. The app tells you where to run to escape the zombies.

The second exhibit that caught my eye was Australian cigarette packaging. This has gone further than UK cigarette packaging, in that nearly all of the packet is made of up disturbing imagery of smoking-related diseases and brand logos are absent. All colour palettes have been replaced by Pantone 448C, identified as the least attractive colour for packaging from market research by the Australian Department for Health and Ageing.

These two designs show psychological understanding being harnessed to provide useful interventions in an everyday context. The first shows short-term reward being used to reinforce exercising behaviour, the second shows health promotion campaigns harnessing the power of imagery and acting to limit the subliminal power of branding.
Whether it is the psychology of design you are interested in or not, the exhibition is worth checking out, for the diversity of the exhibits and to see what is being rated in the world of design at present.

Reviewed by Lucy Maddox who is a clinical psychologist in the NHS and Associate Editor for 'Reviews'

 

Flatten, talk and check
Horizon: How to Avoid Mistakes in Surgery
BBC

In this programme, Dr Kevin Fong who is a Consultant in Anaesthesia at University College Hospital, London, explored the human factors that can impact upon patient safety, focusing on the lessons that can be learned from other professions. The Elaine Bromley case is used throughout the programme to consider how the decisions and actions that members of a surgical team take under pressure can lead to adverse outcomes – in this case, leading to the death of the patient 13 days after a routine operation.

Dr Fong began by demonstrating a simple experiment designed to examine the impact of cognitive load. This showed that, when experiencing cognitive load, our capacity to monitor other stimuli reduces significantly, seriously impairing our situational awareness. The fire service has developed a range of techniques to enhance the situational awareness of fire-fighters, who regularly deal with competing demands in emergency situations. Simulations allow them to practise decision making under extreme pressure, and the training is resulted in considerable benefits. Such techniques are now being used to help doctors in training to develop strategies to cope under pressure. Dr Sarah Cheavley-Williams, also of University College Hospital, is leading the development of human factors simulation training within their medical training programme. Dr Fong suggested that improved situational awareness gained through the use of such techniques may have enabled the consultants involved in the Elaine Bromley case to take a step back and consider alternative treatment options, rather than merely repeat the unsuccessful interventions that they had already tried.

Lessons that can be learned from safety procedures used by the aviation industry and Formula One (F1) racing were also considered in the programme. Surgical checklists have recently been developed based on those used in aviation in order to enhance team working and decision making during surgical procedures. An evaluation of the benefits of using these checklists conducted in eight countries, has found a 35 per cent reduction in surgical complications and death overall. This success is attributed in part to a 'flattening' of the hierarchical structure traditionally found in surgical teams. The potential negative implications of such hierarchies was well illustrated by Elaine Bromley's case – during her surgical procedure, a nurse had suggested an alternative solution to the consultants several times, but she had been ignored. A flattened structure and clearer communication channels may well have led to a different outcome.

The importance of leadership, clear roles for team members, and designated personal responsibility for a small number of tasks are the lessons that can be learned from F1 racing. Introducing such processes directly after surgery and during patient handover to ICU has led to a 40 per cent drop in human error. Again, clear communication, flattened hierarchies and well-defined roles combine to support medical staff in making accurate and effective judgements to benefit patient outcomes.

Finally, Dr Fong presented evidence that introducing training to help medical staff recover quickly from errors, the development of procedures that are standardised, but will encourage innovation where required, together with effective multidisciplinary teamwork can help medical teams reduce human error and deliver a powerful impact on patient safety.

Reviewed by Siobhan Wray
who is a Senior Lecturer at Sheffield Hallam University

Another episode of Horizon looked at the cognitive and social foundations of taste: recognised as the sense most associated with pleasure. The evolutionary nature of taste featured strongly, describing our preferences for sweet and fatty foods as high-calorie sources, rather than bitter and sour flavours indicating potential harmful toxins. Various researchers described their quests to locate the ideal, natural sugar-replacement to satisfy our evolutionary needs: varying from tomato-based to 'Miracle berry' sources. Perhaps most interesting to me was the work of psychologist Professor Linda Bartoshuk on the individual variability of taste receptors on the tongue and their extreme effect on flavour perception.

With evidence from both large-scale research and case studies, this programme provided a broad, interesting introduction to taste research. Ending with a discussion on the social environment of human eating, the documentary ended with some resonating thoughts on taste and the obesity epidemic in modern society: ripe for future Horizon coverage.

Reviewed by Emma Norris who is a PhD student at University College London

Our best friends? Perhaps…
Attachment to Pets: An Integrative View of Human–Animal Relationships with Implications for Therapeutic Practice
Henri Julius, Andrea Beetz, Kurt Kotrschal, Dennis Turner & Kerstin Uvnäs-Moberg
Co-authored by biologists and psychologists, this book delivers an excellent review of both biological and psychological theories and studies, providing a valuable resource for beginners and more knowledgeable readers on both human–human and human–animal relationships.

The focus is mainly on the biological effects of oxytocin (a physiological chemical involved, amongst other functions, in the reduction of stress and fear), the psychological theories of attachment and caregiving, and the development of dysfunctional human–human interactions. Evidence for the benefits of human–animal interactions is also explored, and the authors then postulate a model of human–animal relationships, incorporating these factors, to explain how animal-assisted therapy can help human well-being and human–human relationships. The book finishes with a brief chapter on the practical implications of this model for therapy.

Despite being a thin volume, it is densely packed with information. Overall I really enjoyed the book, it furthered my knowledge on the topic, ignited my interest as both a researcher and a therapist, and it was fascinating to think of the potential for future research and animal-assisted therapy.

Hogrefe; 2013; Pb £27.90
Reviewed by Kate Sparks who is a Chartered Psychologist

 

Art and analysis                                                                                     
The Rinse Cycle
Jim Shaw
Jim Shaw's work will always attract the attention of a psychologist; if not for the themes of the art (perceptions of pain, exploring suicide through ripped up self-portraits, analyses of dreams and the unconscious mind, narcissism) then for the artist's description of himself. As a self-diagnosed 'attention deficit sufferer' and interpreter of his own dreams, Jim Shaw certainly puts on a good show. His series have previously been shown only in isolation; however, for the first time, they have been brought together in 'The Rinse Cycle' at BALTIC in Gateshead, a two-floor exhibition comprising over 100 pieces taken from Shaw's back catalogue (see tinyurl.com/cjabdrr).

I was fortunate enough to attend his end of show Q&A session with the BALTIC curator, and I couldn't resist asking a few non-arty questions. First I asked how someone with ADD has the persistence to work on one series for years. Although he sets out with a theme, he answered, the diversity of the pieces within each theme represent his frequent loss of focus, changes in direction and need to start something new. The final theme, he revealed, is usually the sum of its somewhat eclectic parts, rather than a focus from the start. Maybe this is the art equivalent of naming that last factor in an exploratory factor analysis.

Some of his most disturbing works come from his 'Dream Drawings', which serve as pieces in their own right but also as a repository for his future pieces. When asked about his dream pieces, Shaw suggested that most dreams are boring, but when you start making your dreams into art for a living, the subconscious kicks in to provide you with material. This seems like quite useful system for a commercial artist.
My non-arty questions seemed to surprise Shaw, but the answers removed some of the arty mystique of his work. Whether his pieces are actually manifestations of his subconscious or just consciously creative is neither here nor there; the themes make sense, even if they are applied post-hoc, and the individual pieces are amazing.

BALTIC Centre for Contemporary Art (November 2012 to February 2013)
Reviewed by Dr Mark Wetherell who is a Reader in Psychobiology & Health Psychology at the University of Northumbria