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Self-harm and suicide

‘We have a significant contribution to make’

Ian Florance meets health psychologist Rory O’Connor.

25 May 2013

Where did you grow up? Tell me a bit about your childhood.   
I grew up in Derry, Northern Ireland in a family of five boys. It was a happy place to grow up and family is very important to me. I have an identical twin brother who is also a Professor of Psychology and being a twin is a defining feature of who I am. We're mirror twins which means we're genetically identical but, among other things, I'm right-handed and he's left-handed. Our father was also an identical twin so, unsurprisingly, being a twin has always fascinated me.

What interested you in psychology?
Aside from my interest in nature/nurture – on the back of being a twin – I remember meeting a psychologist at school and this first awakened my interest. Although psychology, medicine and ophthalmology – I have no reason why the latter! – all interested me as a teenager, psychology was always my number one focus. One of the things that I liked about all those areas was that, rather than emphasising the acquisition of knowledge for its own sake, they used knowledge and evidence to help people.

Where did you study?
Queen's University, Belfast (QUB). It was an exciting and thriving place to be a student. One of my abiding memories as a first-year undergraduate was of Ken Brown teaching us developmental psychology. He was an extremely enthusiastic lecturer, brilliantly peppering psychological science with amusing anecdotes. Like many students I hadn't anticipated the amount of statistics involved in the degree, but I came to enjoy them.

Why did you choose health psychology?
Although my interests were always at the intersection of clinical and health psychology, I have always been impressed by how health psychology, as a new subdiscipline, drew from other areas of psychology. It crossed boundaries and wasn't constrained by its past. Also, as I view suicide and self-harm as 'health' behaviours, I felt that the theoretical approaches that characterise health psychology could and should be extended to understanding them.

How did you get interested in these particular topics?
From my earliest days in psychology, I was interested in the aetiology and course of emotional distress as well as how people respond differently to the same events. This led to an undergraduate dissertation which investigated the interplay between personality and cognition in the context of the learned helplessness/hopelessness paradigm. In many ways my work on suicide and self-harm was a logical extension of my undergraduate work. However, I got seriously involved in studying suicide serendipitously through the intervention of Noel Sheehy, one of my tutors at QUB. Although I had originally applied for PhD funding to extend my undergraduate work, Noel got in touch out of the blue in the summer following my graduation to say that there may be funding to do a PhD on suicide in prisons. To cut a long story short, the suicide in prisons funding didn't come through but this had whetted my appetite for suicide research, so I continued in that field with Noel, thanks to a QUB scholarship. I'll always be grateful to Noel for his support and enthusiasm during my PhD. Recent personal experiences of suicide have only served to further drive me in the field.

Have you any observations about the field of suicide research?
What struck me most when I started working on my PhD was the relative lack of coherent theories of suicidal behaviour which went beyond psychiatric risk factor profiling. There were countless publications on the epidemiology of suicide and self-harm but little theoretical work. So, for the last 10 to 15 years I've been trying to build a theory of why people kill themselves.

As alluded to earlier, historically, suicide has been viewed almost exclusively as a 'clinical' phenomenon but it is much more than that – it results from a complex interplay of social, cultural, biological, psychological and clinical determinants. To understand suicide, we have to accept that first and foremost it is a behaviour, and this view opens up many avenues of investigation including the use of theoretical models from all areas of psychology (and beyond) to understand why suicide happens in some people but not others.

You seem to be implying that crossing boundaries within psychology helps.    
Yes. Psychology has become too splintered. Arguably we have been become too focused on the adjective before our titles, losing sight of the bigger picture. In my view, what divides us within psychology is far less important than what unites us. While the profession spends a lot of time minutely distinguishing different types of psychology, people outside – other academics and professionals, policy makers, clients, sponsors, a lot of the media – see us as psychologists pure and simple. I fear that psychology as a profession can create unnecessary division. We need to be careful not to weaken the discipline further, and we should strive to be more outward-looking. Indeed, interdisciplinary working is at the heart of addressing the 'big questions' and with the growth of research impact in the Research Excellence Framework, interdisciplinary partnerships are vit

And you've worked with policy makers and politicians to make an impact.   
Yes, I see it as part of my job. Ever since I started working as a psychologist, I have been keen to ensure that the accumulation of scientific knowledge was not kept locked away in ivory towers, and over the years I have tried to influence public policy on suicide/self-harm-related issues. In recent years I've worked with the Scottish and Northern Irish governments on suicide prevention policy and practice and regularly work with suicide prevention organisations nationally and internationally. Psychology has a lot to contribute to public discourse, providing sound research methods, coherent theories and robust data which should inform decision-making and the development of effective solutions to complex problems.

Health psychology seems to have changed a lot over the last 10 to 20 years.                                                                                                 
In my view, the early days were very much about establishing the discipline and developing the theoretical foundations of the prediction of health behaviours and the course of ill health and disease. I think there has been a step-change within the discipline, with much more emphasis on translational research. We're now involved in applying what we know to real-world contexts by developing and implementing theory-driven behaviour change interventions across the spectrum of acute and long-term conditions. We are also very much focused on prevention as well as intervention and the long-term management of illness and disease.

And what about the future?    
I am hopeful that psychological science and psychologists will have greater influence on policy and practice and that we can have a really positive impact on people's lives. I enjoy training psychologists in this area, and I am particularly keen on developing novel ways in which undergraduates, postgraduates and researchers can network and learn from each other.

I'd like psychology graduates to become much more aware of the skills and competencies that they develop throughout their training. In my experience, employers really appreciate the wide variety of competencies/skills that psychology graduates acquire. Psychologists are good at report-writing, group working, applying the scientific method, communicating and critically appraising data and arguments, among many other skills. I think psychology does a good job in producing rounded students but I think we ought to make these transferable skills more explicit.

I also want to encourage psychologists to influence policy more rather than being nervous about it. As long as we have good evidence we have a significant contribution to make.