THE LOOKING January 2013 GLASS Issue One
INSIDE:
Debate: ‘Global Mental Health is Westernised Medicalization of Distress’
Careers focus: science writing An interview with Professor Sir Robin Murray ...and much more
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Contents January 2013
On the Cover 4 Careers focus: science writing 10 Debate: ‘Global Mental Health is Westernised Medicalization of Distress’ 18 Interview: On the Coach Professor Sir Robin Murray
Inside 3 Welcome 8 Feature: Living with Depression 12 Reviews:
Wake Walking Through Our Dreams: A Review of Waking Life (2001) A Modern Day Masterpiece: A Review of Amour (2012) 14 News and Events 15 BlogSpot: Between an educated rock and an academic hard place 16 Editorial: The Art of Communication
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The Looking Glass | 3
Careers CURRENT PHD STUDENT EMMA PALMER CONSIDERS SCIENCE WRITING AS A CAREER AND TALKS TO THOSE IN THE BUSINESS ABOUT THE IMPORTANCE OF SCIENCE COMMUNICATION
Communicating science: Science writing A s a scientific institute it is important for those of us at the IoP to keep communicating up-to-date findings to a wider audience than just the recipients of relevant academic journals. In the field of psychiatry this is especially important, as ours is an area of research that the general public tend to shy away from, with social stigma still clouding peoples understanding of common mental illnesses. So, to help get the word out we need to encourage a new generation of science communicators, but how do we go about doing this?
Science communication is not simply reporting your data to ‘Nature’ (if you’re lucky!) then sitting back and feeling satisfied that people have access to your research. Nor is it copying said report into a blog or sending it to New Scientist. Being a good science communicator is having the ability to communicate important information to the general public in a manner that makes it accessible and
understandable to the lay person. We spoke to Claire Bithell, Press Officer for the Science Media Centre, who told us that a good science writer is ‘someone who is curious about science, who has a talent for explaining complex ideas in simple terms. They need not be an expert in the area they are writing about, and in fact to be a good science writer you need to be able to quickly absorb new information and gain insight into new areas.’ The Association of British Science Writers added that a science writer is someone with ‘a passion for telling a good story, an interest in other people, and being able to see things from the perspective of your audience. It’s not just about being a good writer or about the science it’s about being able to spot what makes a good story, and pin pointing why someone else should care about it.’ I’ll never forget my PhD interview here at the IoP. After all the standard questions about my educational background and
#overlyhonestmethods We spoke to Dr Leigh, a post-doctoral research neuropharmacologist and author of the blog ‘neurodynamics’. Recently she came into the scientific public eye as the ‘founder’ of the scientific twitter craze ‘#overlyhonestmethods’ (some of our favourites can be found on the following pages). Why do you think science communication is important? I think that doing science is only part of the scientist's job description. We absolutely have to talk about science outside of our professional circles and work to make science a part of the general public awareness. Often our work is funded 4 | The Looking Glass
focus
research interests I was asked to expand on the interest in science communication that I had expressed in my cover letter. I eagerly started gushing about how important it was to make science accessible to the general public, whilst also making it exciting, and dropped in a few of my favourite writers and publications. However, when asked to talk about a recent piece of science communication I enjoyed reading, I got the classic interview brain freeze. All the exciting articles I had read in the week leading up to my interview had completely disappeared. Horrifically, I was left with just one word…‘Gonorrhoea’. Even worse, as I launched into this discussion of an antibioticresistant strain of gonorrhoea to a panel of neuroscience and psychology experts, I happened to let slip that it was written in the Metro. Their faces dropped. However, all was not lost. I managed to pull them back on to my side by explaining that, though I don’t
read the Metro primarily for its scientific acclaim, the piece had managed to explain what could be a very confusing scientific concept of evolving bacteria into an interesting snippet of science, suitable for the lay reader. Safe to say, their faces had returned to much more encouraging expressions by the end of my spiel, and with a nod of approval the conversation moved to safer topics. Phew! Amusing anecdote aside, this article was the first to show me that you don’t have to be published in New Scientist to be an accomplished science writer. The aim is to make your points accessible to the non-scientific audience, which is exactly what this author did. In an ever changing web-based environment, the current age of blogging has revolutionised how we are able to share our thoughts and report on new and exciting scientific concepts, as well as increased our reach to
the non-scientist audience. For this reason the quality of science writing and the science journalists entering the field needs keep up with these developments. A final word of advice from the ABSW: ‘don't narrow your job search to just journalism. There's a lot more to science writing than just journalism. Plenty of good science writing goes on in organisations, press offices and other places.’ When we spoke to some experts and big names in the field about how to get started, an overwhelming majority recommend you just ‘start writing’. It’s that simple. If you want to find out a bit more about how to get into science writing, what it’s like working in the field, and how the experts think it’s changing, have a look at our interviews in the following pages.
publicly, so we can be reasonably expected to be able to describe the gains provided by the public's investment. But making the public aware of our work may help us out in return- wellinformed people who understand the benefit of science, who feel confident that science is making advancements in society, are more enthusiastic about continuing to support science! We exist in this mutually beneficial state that takes attention on our part to maintain. What can people, especially students, do to get involved in science communication? When you're a student it's a great time to get started communicating science with the world around you, but anyone can get involved. It doesn't have to be a big deal. It can be as simple as sharing your enthusiasm for science by pointing out a cool natural phenomenon/technology/medical practice/policy decision (and many more!) and the science behind it, or having an "elevator pitch" - a brief description of who you are and what you do that would make sense to anyone you may encounter while you're out and about. Somewhat more formal ways might include sharing scientific stories or facts of interest on a blog, or on twitter, or even in your facebook feed. But really, I think your day to day communications and actions on their own go a long way to show that scientists are just regular folks with a cool job, that science is for everyone who's interested, and there are some really great things we can do with science (and many more yet to be dreamed up).
Want to know more?
How, in the new medium of blogging and twitter, has science communication changed, or how does it need to change? My take is that scientists are more accessible than ever thanks to the internet. There are many of us out there participating in all levels of conversations. I think one thing that could change is that, like most people, we gravitate toward in-group conversation. There's nothing wrong with that, but I think some well-placed explanations to keep the conversations accessible to someone without the highly specialized knowledge would keep the communications more open with the general public.
Check out:
Ed Yong’s blog post ‘On the Origin of Science Writers’, in which over 100 science writers give their view on what it takes to become a science writer: http://blogs.discovermagazine. com/notrocketscience/2010/ 07/29/on-the-origin-of-science-writers
The Science Media Centre webpages: www.sciencemediacentre.org/
The Association for British Science Writers: www.absw.org.uk/
The Looking Glass | 5
Ask the experts Association of British Science Writers What’s the best way to get into science writing?
writing), also it's very easy to be very bad!
There are of course many formal degrees and training courses and these have proved really useful for some seeking work in science communication more broadly and science journalism more specifically. However, the best way to get into science writing, regardless of whether you are on a course or not, is just ‘do it’. The more you write the quicker you'll find your voice and get used to the habit of writing. Reading others work from a whole host of sources and analysing what it is that you like about your favourite writers is also invaluable in giving you ideas for stories and styles of writing.
Why you think science communication is important?
Do you have any advice for budding science writers? Speak to as many science writers as you can - many are on social media (especially Twitter) or you can interact with them in blog comments. It's a friendly community and everyone's willing to offer advice - make contacts where you can - you never know when they'll be useful.
It might be a cliché, but science really is a part of almost everything and it is for everyone. To be able to bring it to people and overcome their 'oh it's too hard' preconceptions is a really noble calling. If you are a fan of what thinking scientifically has achieved and what it can continue to do for our society, then you'll no doubt enjoy making science part of the national conversation, a part of everyday culture. One important point to make here though is the clear difference between science communication and science journalism. One is engaging the public with science, which requires making it interesting and bringing it to life in a different way to journalism, which will necessarily need to take a more critical look at science. Of course, science communication can look critically at science and scientists, and journalism can engage the public, but at a very basic level you need to be aware of the distinction. As has been said many times, journalists should not be ‘cheerleaders’ for science.
Exploit all networking events to their full and just keep pitching your ideas. See this article on how not to pitch as it is a skill in itself! http://www.theopennotebook.com/2012/01/04/how-not-to- In the changing nature of science communication in the current pitch/ age of blogging, how do you think this affects the way you need to communicate and the people you are reaching?
The web has been a great democratic leveller and anyone can now contact anyone else, so if you're a good writer with flair and a passion for the subject, you can progress your career more easily than in the past when there were perhaps more barriers. The interactive and immediate nature of online communication also keeps people on their toes, if you make a mistake anyone can and probably will call you out on it online. In terms of engagement, the web has really facilitated dialogue; we're now finally seeing the public as people whose respect and interest we have to earn. In terms of the actual job though the medium may have changed and you may reach more people via the internet than a printed product, but it doesn't change how you “do” your story. What are the pros and cons of a job in science writing?
So what do you think about blogging?
The pros of the job are that you'll meet brilliantly interesting people, go to places you'd never normally get access to and you'll learn a lot about whatever you're writing about. The cons are it's not necessarily that well paid, getting work is tough (although this applies more to journalism than the broader field of science
Anyone can start a blog and get practising. There really is no excuse. However, as a word of caution, the blogosphere can be a bit of an echo chamber you do need to make sure you are adding something to what others are saying, [be clear] of your audience [and] who your blog is aimed at.
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Claire Bithell: Science Media Centre What’s the best way to get into science writing?
or infectious disease. Therefore, it is important that more mental health researchers come forward to be spokespeople for their area Probably the best way is to just to start writing. Writing a blog, artiof research. The best way to do this is to contact either Louise Pratt cles for your organisation or professional body or for a newsletter or Seil Collins in the Institute of Psychiatry Press Office, and if you are all good ways to build up a body of work. are interested in speaking to the national news media you can also There are also some great competitions for science writers to en- work with the Science Media Centre. ter, for example the one run by the Wellcome Trust and the GuardWhy you think science communication is important? ian. There are also a number of well-respected science communication courses, such as the one run by Imperial Collegeand many Science communication is essential if we want the public, funders people would recommend doing a non-subject specific journalism and policy makers to appreciate the importance of research. Most or writing qualification. science is funded using public money, so I feel there is a duty for researchers to speak to the public about their work. I have seen (See links at the bottom of the page for more information on comtime and time again in my role as a press officer for science that petitions and courses) those scientists who communicate their work are more likely to What do you think makes a good science writer? receive funding and they create a more supportive environment to Though I would encourage everyone working in science to think carry out their research. I also think that many people don’t realise about communication, remember that science writing is not the research offers an opportunity for improved understanding of only way. UK science journalists are some of the best in the world mental illness and better treatments – researchers who communiand are incredibly skilled at communicating research. Working cate with the public have a chance to make this point. alongside these journalists I am constantly in awe of their ability to take a complex piece of research, quickly grasp its significance and limitations, and write a piece of copy that neither dumbs down the work or oversells its importance. These journalists will write multiple stories every day and are equally knowledgeable about space travel, climate change, mental health and infectious disease. They get this expertise by speaking to researchers who have a talent for communicating their area of work – the more experts they have access to the better they will be able to report an area.
With the nature of science communication changing in the current age of blogging, how do you think this affects the way you need to communicate and the people you are reaching?' Science communication is changing rapidly as a result of new media. Science communicators are using blogs, twitter, podcasts and other methods to reach new and existing audiences. That said, if you want to reach a really wide audience that may not have a special interest in science, traditional media often remains the best tool.
And journalists may not know as many experts who work on mental health research as other areas they write about, such as cancer LINKS: Wellcome Trust science writing competition: http://www.wellcome.ac.uk/funding/public-engagement/science-writing-prize/index.htm Imperial Science Writing Course: http://www3.imperial.ac.uk/humanities/sciencecommunicationgroup/masters/mscinsciencecommunication
Inspired? Want to start your career in science writing right here with us? Submit articles to the Looking Glass and get practising those science communication skills. Find out more on page 20 or check out our Facebook page: http://www.facebook.com/TheLookingGlass2012
The Looking Glass | 7
Living with Depression Emma Quinlan shares a friend’s experience of depression and the struggle of switching medication.
M
ental illness used to be a topic rarely discussed but nowadays people more often come forward to talk about their experiences. Eight years ago at the age of 16, my best friend told me that she suffers with depression. Someone who had never met a person with depression might have some preconceived ideas about what to expect. Surely, someone with this disorder must be really sad all of the time and, of course, they could never have any fun. Contrary to such expectations, my friend Louise* is one of the most positive, upbeat and funny people that I know. She is the person I turn to for advice and cheering up. She is smart, witty and caring. However, she also suffers badly with clinical depression. To a stranger Louise appears very ‘together’: she has a degree from Trinity College Dublin, she has good friends and has always had a part time job while she studied. Aside from this, she is also a bubbly and confident person. Unfortunately this means that people, including friends, relatives and most importantly clinicians, have failed to understand how such a happy
person can have depression. Recently, Louise decided to change her medication. She had been on ‘lofepramine hydrochloride’, a tricyclic antidepressant (TCA), for the past four years and for a number of reasons she decided it was time to try something else. Firstly, TCAs are rarely prescribed anymore and have largely been replaced by selective serotonin reuptake inhibitors (SSRIs), which are associated with less severe side effects. Secondly, Louise had some kidney problems when she was born and the particular TCA she was on is not meant to be prescribed to someone with such problems (an issue her previous GP failed to make her aware of). Finally, although the TCA helped to some extent, Louise felt that there must be a better form of medication that would allow her to feel happier on a daily basis rather than simply ‘coping’. Coming off lofepramine was both a brave and somewhat dangerous thing to do as it was not clear how Louise would react to being without her usual dose of medication. She changed GPs and her new doctor supported her decision to stop taking the TCA, agreeing
*Louise’s name has been changed for confidentiality
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that she would come off the drug over a period of a few months to avoid extreme and dangerous withdrawal effects that she might otherwise suffer if she suddenly stopped taking it. The plan was to decide what new medication Louise should go on over those few months. It might sound simple, but it has been a big struggle for Louise. This was something she knew wasn’t going to be easy, she purposefully waited until she had graduated from university and also quit her job of 6 years so that she could finally focus on achieving what most of us take for granted - the ability to lead a happy daily life. The first reduction seemed to be the hardest; she was on two thirds of her original dose and felt very low. It is difficult to describe depression and what it feels like but I talk to Louise every day and feel that I have a good insight into how both depression and coming off her medication has affected her. From our conversations, it seems to me that the biggest problem is her feeling of negative selfworth, she sees herself very differently to the people who meet her. She has often said to me that she feels she is not worthy of the life that she has been given and this has played a part in the most desperate aspect of suffering with depression, suicidal ideation. Louise has confided to me in the past that she thinks about suicide but she also remains certain that she would never act on it because she has family and friends who she cares about and she would not want
ANTIDEPRESSANTS: QUICK FACTS There are almost thirty antidepressants available today of four main types: SSRIs (Selective serotonin reuptake inhibitors), SNRIs (serotonin and noradrenaline reuptake inhibitors), tricyclics and MAOIs (Monoamine oxidase inhibitors). Tricyclics and MAOIs are used less often.
According to the RCPsych, around 50% of people with moderately severe depression treated with antidepressants compared with 20% of those on placebo are much improved following 3 months of treatment.
to see them hurt. However, living for others alone is not enough and is a prime example of why she needs to be on better antidepressants that allow her to do more than just ‘survive’. Coming off medication was a full time job for Louise. A few weeks ago the suicidal ideation worsened and we were both very worried. Luckily she made it through but she still has a long way to go in her journey. Louise is now off the TCA and has started a drug that targets the glutamatergic system rather than the monamine system. However, the major problem with her situation is the lack of support from clinical professionals. Her
LIVING WITH DEPRESSION
“Coming off lofepramine was both a brave and somewhat dangerous thing to do”
EMMA RECENTLY COMPLETED HER MSC IN COGNITIVE NEUROSCIENCE AT THE IOP AND IS NOW FIGURING OUT WHAT TO DO NEXT… POSSIBLY A PHD!
doctor was helpful but reluctant to be solely responsible for choosing Louise’s new prescription and recommended that she see a psychiatrist. This was not as easy as it might sound. Louise has seen psychiatrists in the past, none of whom has seemed to really understand her depression. On top of this, with a one hour session costing approximately £150 only wealthy people can afford to see a psychiatrist. For those for which this is not an option you can expect to go on a 6 month waiting list. For someone seriously depressed waiting so long for help is simply not a viable solution!
Fortunately Louise’s doctor managed to get her an appointment with a local psychiatrist at a reduced rate. Unfortunately, once again, this psychiatrist did not understand the severity of Louise’s situation. Although she has told him blatantly that she struggles daily, suffers with insomnia and has thought about suicide, he told her that she ‘just doesn’t seem like someone with depression’ and that if she was really depressed she would be unable to get out of bed and he even said that she would be selfharming. They spent her first two sessions arguing about if she actually has biological depression and if she should be prescribed antidepressants or not. When she told me this I was enraged on her behalf.
I have witnessed my friend struggle through the years that I have known her. She says that she can’t remember a time she has not felt that she has depression. Her first suicide attempt occurred at just eight years old and the fact that her mother has been on antidepressants for the past 20 years indicates potential heritability of the disorder. However, Louise has battled the darkness of depression over the years and managed to carry on with life. She has had days where she cannot stop crying but also days out with friends laughing. She has felt utterly hopeless but still taken small steps in life to fight the disorder and enjoy herself. She has managed to compartmentalise many of her feelings so that she was able to get a degree and have a job and a social life but this does not mean that she does not suffer with depression. People that meet Louise may not be able to understand that this seemingly happy girl could possibly suffer in the way she does and, on the one hand, this can be a good thing allowing her to get on with life. However, the fact that a trained psychiatrist fails to understand the complexity and severity of mental health is not acceptable. In my studies I have developed some understanding of the biology of depression whilst my experiences as Louise’s best friend have shown me how the symptoms may manifest and how they can make daily life very difficult. I know that doing positive things like exercise, eating healthily, meditation, talking with friends and family and taking up a hobby all help with a person’s mental health but I am also sure that with a disor-
der as serious as Louise’s that pharmacological treatment is a necessity for her. I know that there are many great scientists and clinicians in places like the IoP and around the world doing a lot of work and research in order to understand mental health disorders and how to treat them. This is fundamental as so many people struggle with mental health issues, which vary in their severity but all of which should be acknowledged and treated. It is important to treat each person with a mental health disorder individually and try to detach the stigma from the disorder. The way in which Louise has been treated with medication is through trial-and-error, she tries an antidepressant and waits to see if it works and how well it works, which can be time consuming and disheartening. We need to understand the heterogeneity of depression and perhaps by identifying different biological subtypes, using technology such as brain imaging, we may be able to chose appropriate medication on an individual basis. Science and medicine have made huge progress over the past 50 years in understanding all kinds of disorders including epilepsy, dementia, neurodevelopmental disorders and mental health problems. I therefore remain optimistic about both the present and future understanding of clinical depression. In the meantime, I am also hopeful that Louise will find a treatment that helps her to lead the life she deserves and to move on from this difficult journey that she has been going through.
The Looking Glass| 10
DEBATE
FOR
Global Mental Health is Westernised Medicalization of Distress
What is 'global mental health'?
mental health services worldwide.
I think that anyone who believes (2) above is Psychiatry is a huge field but it cannot even living in a parallel universe. define its primary object, 'mental disorder', it cannot say what a mental disorder actually is. Whilst there is rhetoric about respect for local Instead it points to its methods: if sufficient traditions and perspectives, the reality is a phenomena at sufficient threshold can be global deployment of a narrowly biomedical, gathered together, a mental disorder is de- Western model of mental disorder. The field clared to exist! This is modern alchemy. gives itself away when it says the task is to So what exactly is 'global mental health'? Can any standard of mental health be definitive universally? For, if not, the term seems an oxymoron. One of the most comprehensive accounts of the field, its operating assumptions and aspirations is to be seen in The Lancet Global Mental Health Series, 2007. This was intended to be a seminal compilation and to represent the WHO position. The Series made three core statements: (1) Mental disorders represent a substantial, "though largely hidden", proportion of the world's overall disease burden; (2) Every year up to 30% of the global population will develop some sort of mental disorder; (3) There was strong evidence for scaling up
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“Global mental health workers are the new missionaries.� address the 'treatment gap': this means exporting what we have, and they do not, and are judged to need. 'Local initiatives' here means training local workers to administer western mental health technologies. But to assume that western psychiatric categories like 'depression' are universal is to commit an error of validity. Invalid approaches are those which fail to address the felt 'nature of reality' of subjects and thus cannot be humanistic and cannot work. To cast Western knowledge as universal, whereas indigenous knowledge is merely local and ignorable, is to propagate a new imperialism. Global mental health workers are the new missionaries.
Global mental health is mostly a 'top-down' movement whose effect is to sell the products of the Western mental health industry to the non-Western world. Good news for the pharmaceutical industry. Yet the evidence base for, say, antidepressants or talk therapies is weak and contested even in the West. Most of the variance of outcome is accounted for by non-specific or placebo factors. And what of context? The World Bank calculates that 1.4 billion people in the world are in 'absolute poverty', which is to say they are mired in bare survivalist modes of existence and will never have a decent meal in their whole lives. As many again are scarcely better off. The UN Children's Fund (UNICEF) says that 3.5 million children under the age of 5 die of starvation every year. These are "the Wretched of the Earth", to use Fanon's phrase: would anti-depressants and Western talk therapy improve their lot? Who in the non -Western world is asking for them?
Dr Derek Summerfield is an SLAM Honorary Lecturer at the Institute of Psychi-
Add your voice to the debate:
Send your comments and opinions to iopmag2012@gmail.com or post your comments on our Facebook page.
Want to be part of a debate in future issues? We also welcome suggestions for future topics.
AGAINST When would a ’sad’ person receive a diagnosis of depression? Ideally, if they have ‘pathogen D’ in their blood or ‘raised D titer’ in their serum or ‘lesion D’ in MRI scan of the brain or ‘raised byproduct D’ in their urine and so forth. Biological markers are the best validators for any diagnosis. Significant advances have been made in delineating the biological concomitants of psychiatric syndromes. However, practicing psychiatrists for the past two centuries have been acutely aware of the limited understanding they have about the fundamental underlying biological mechanisms leading to mental disorders¹. The main reasons for this limited knowledge relate to the complexity of mental functions; the evolutionary and complex nature of causal mechanisms; the challenges of accessing the brain; the reliance on treated samples; and the relative underinvestment in such research.
“We know that mental disorders, such as psychosis and depression, are universal phenomena.” Whilst looking for more definitive biological markers researchers and practitioners have been using alternative validation criteria to diagnose mental disorders. The defining work in this area was done by Samuel B Guze and Eli Robins², who described five phases of validation: clinical description, laboratory study, exclusion of other disorders, follow-up study
and family study. The classification of mental disorders in both the ICD-10 system and the DSM-IV system relies on the Guze-Robins principles. Diagnoses that employ these principles, although they may lack confirmatory biological criteria, “by virtue of information about outcome, treatment response and aetiology that they convey…are…invaluable working concepts for clinicians”³.
Using this principle we have learned a great deal about various disorders. Even when considering the less precise diagnosis of depression, several researchers, using qualitative, ethnographic and other robust research methods have confirmed the importance of depression in various cultural settings⁴⁻⁷. Any critic of global mental health must have the intellectual integrity to acknowledge the key steps that have been taken to support the validity of psychiatric diagnoses, the willingness to grapple with the uncertainties and the courage to participate in the endeavour to improve validity. Moreover, while not ignoring the question of validity, we should go beyond the simple rhetoric about validity to the most important question to answer at this juncture: Do we know enough to act in a meaningful way to reduce the symptoms and disability of people with mental disorders? The answer is an emphatic yes.
We know that mental disorders, such as psychosis and depression, are universal phenomena. We know of the devastating impact of these disorders on individuals and society. We know that mental disorders are associated with substantial and often socially isolating stigma, human rights violations and increased mortality. There is also sufficient evidence confirming their treatability⁸. However, the ‘mental health gap’ means that in all countries at least two thirds of people do not receive any effective treatment⁹⁻¹⁰; and that even in high income countries the average life expectancy of people with mental illness is at least 15 years less than their non-mentally ill counterparts¹¹⁻¹². Mental health, although one of the highest contributors to the global burden of disease, remains least funded¹³.
Early in the 21st century, what we witness is the ongoing and unacceptable ‘failure of humanity’ to use the available tools and opportunities to address the need. Yet, mental health research is one of the most exciting fields of research. With its unparalleled challenges and opportunities, the frontier of medicine in the 21st century is global mental health, if we can harness what we know to navigate the future wisely and effectively.
Dr Abedaw Fekadu is an Honourary Clinical Lecturer and Prof. Graham Thornicroft is a SLAM Consultant Psychiatrist.
1.Wise S. Inconvenient people: lunacy, liberty, and the mad-doctors in Victorian England. London: The Bodley Head; 2012. 2.Guze SB, Robins E. Establishment of diagnostic validity in psychiatric illness: application to schizophrenia. Am J Psychiatry 1970;126:983-7. 3.Kendell R, Jablensky A. Distingushing between the validity and utility of psychiatric diagnoses. Am J Psychiatry. 2003;160:4-12. 4.Abas MA, Broadhead JC. Depression and anxiety among women in an urban setting in zimbabwe. Psychol Med. 1997;27:59-71. 5.Okulate GT et al. Somatic symptoms in depression: evaluation of their diagnostic weight in an African setting. Br J Psychiatry. 2004;184:422-7. 6.Orley J, Wing JK. Psychiatric disorders in two African villages. Arch Gen Psychiatry. 1979 May;36(5):513-20. 7.Patel V et al. Depression in developing countries: lessons from Zimbabwe. BMJ. 2001;322:482-4. 8.Patel V, Thornicroft G. Packages of care for mental, neurological, and substance use disorders in low- and middle-income countries: PLoS Medicine Series. PLoS Medicine. 2009; 6(10):e1000160. Epub. 9.Dua T, et al. . Evidence based guidelines for mental, neurological and substance use disorders in Llow- and middle-income countries: summary of WHO recommendations. PLoS Medicine. 2011;8 1-11. 10.Thornicroft G. Most people with mental illness are not treated. Lancet. 2007;370.9590:807-08. 11.Thornicroft G. Physical health disparities and mental illness: the scandal of premature mortality. Br J Psychiatry. 2011;199 441-42. 12.Wahlbeck K, et al. . Outcomes of Nordic mental health systems: life expectancy of patients with mental disorders Br J Psychiatry. 2011;199:453-58. 13.Kingdon D. Health research funding: mental health continues to be underfunded. BMJ. 2006;332:1510.
The Looking Glass | 11
Wake Walking Through Our Dreams: A Review of Waking Life (2001)
A
t its core, Waking Life delivers an existential head trip (pun intended) that will leave you, as any good trip will, with more questions than answers. The film follows a nameless main character (Wiley Wiggins) who is seemingly trapped within a lucid dream state. If you are feeling in the mood for colourful explorations on topics ranging from the meaning of love to telescoping evolution and the future of humanity then this film is for you.
Reviews films,booksandmore
Waking Life was the first feature length film to employ a rotoscoping technique in which artists use computers to trace over live actors filmed using digital video. The use of animation brings an added dimension to a film that consists mostly of ‘talking head’ style interviews. The employment of several different animators gives the director a freedom of expression that ranges from the subtle to blatant exaggerations of the human form. This film attempts to bring awareness to many of the hard questions that we all face in our daily lives that often elude our conscious thought. Our main character encounters scholars, artists and the average bloke in his lucid exploration of his life and self. Feelings of existential isolation, free will, dreams and the nature of the mind and death are all explored. If you are feeling in the mood to stop sleep-walking through life and wake up to the “ongoing wow that is happening right now”, then take a trip with Waking Life.
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A Modern Day Masterpiece: A Review of Amour (2012)
T
he opening scene of Amour depicts fire brigade personnel breaking into an elegant and homely Parisian apartment to discover the lifeless body of an elderly lady, laid to rest with flowers in hand and sprinkled petals adorning her pillow. From the onset, there is no escaping the anguish and torment of death in this harrowingly beautiful film. Recipient of this year’s prestigious Palme d’Or at the Cannes film festival (with the director Michael Haneke recognized by judges for a second time following the excellent The White Ribbon in 2009), Amour tells the tale of a devoted, loyal and ageing couple as they cope with the physical struggle, and then unrelenting decay of the mind, following two stroke events. The couple comprises of ardent pianists Anne and Georges, acted with the upmost humanity and compassion by Emmanuelle Riva and Jean-Louis Trintignant respectively. In an early scene, the couple are visibly moved by a mesmerising concert and upon returning home to the aforementioned apartment, which herein becomes the intimate mise en scene, the tender Georges asks Anne before retiring to bed, ‘Did I mention that you look very pretty tonight?’. In this sweet questioning, in their joy for music and in more subtle instances throughout, Haneke purposefully portrays an emotional and intellectual vitality to the lives of this couple despite their obvious physical frailties. This serene state of affairs is soon turned upside down as Anne endures a stroke that renders her paralysed down her right side. It is here that the hugely topical theme of ‘burden of care’ becomes prominent as Haneke makes an emotive point through Georges’ struggle to find a nurse to match his benevolent care of his wife. Moreover, where one goes if you are not blessed with the dutiful Georges as your loving partner makes for frightening introspection (even at the tender age of 23!). Anne develops full-blown dementia and in some instances it is excruciating to observe this progressive and debilitating decline, particularly when contrasted to her previous acuity. Georges, however, never abates in his thoughtful and doting care of his wife, making for an astonishingly beautiful and heartfelt portrayal of true love and devotion. Whilst Amour’s atmosphere is principally a sombre one and its culmination painfully inevitable, there are humorous and poetic flourishes throughout, not to mention some stunning cinematography and an intriguing subplot relating to Anne and Georges cultivated and self-obsessed daughter. Despite this, do not expect to enjoy Amour although its poignancy makes the film compelling viewing. Certainly, the stunned silence of my fellow audience members throughout the entirety of the credits supports this notion. A modern day masterpiece.
Seen a good film, read a good book? Why not review it for The Looking Glass? We are interested in works in any media that have relevance to psychology, psychiatry and neuroscience, however loosely! Send your reviews to iopmag2012@gmail.com and check out page 20 for submission guidelines.
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News and Events
CEMPH AWARD FOR YOUNG WOMEN IN SCIENCE
Student PhD Showcase 2012 Since 2011 the IOP has held their annual postgraduate research Student Showcase. This event offers PhD and MD (Res) students the opportunity to present their work and discuss it with colleagues and staff from other research groups and departments across the Institute. More than 60 students put aside their public speaking anxiety and put their best presentation skills into practice last November. It was a tough decision but after some deliberation judges chose two lucky winners, both of whom went home with £200 Amazon voucher. Carol Shum (PhD in Clinical Neuroscience) and Marcella Fok (MD (Res) in Psychological Medicine) won first prizes whilst three runner-ups were awarded with £100 Amazon vouchers each (pictured). Proud supervisors and those unable to attend got a second chance to have a closer look at the winning posters as they went on display in the Wolfson mezzanine area. This event was thought to be not only an excellent way to increase awareness of the high quality research that was ongoing at the IOP but an enjoyable day meeting other researchers and hearing their thoughts on our work all over a buffet lunch with wine. We are now looking forward to the 2013 Students Showcase where even more presentations than this year are expected as part-time students will be also called to submit their work. Special thanks go to the judges, whose feedback and comments were encouraging and helpful and to Student ambassadors and EST staff who organized the event and supported presenters and attendees on the day. Want to publicise your event? Been to a great event at the IOP or elsewhere? Write to us at: iopmag2012@gmail.com
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We are very pleased to announce the launch of a CEMPH Award for young women aged 15-18 with an interest in economics. This is an excellent opportunity for young women from the local area to gain practical experience and make valuable contacts for a potential future career in economics. The Award aims to encourage these young women to stay in education and develop a career in science, technology, engineering or maths (STEM). The Award includes shadowing a member of the CEMPH team for two to three days for the purpose of learning about economics related to health care, plus ongoing mentoring for at least a year and a £50 book token. The Award was conceived and set up by Margaret Heslin, a researcher in CEMPH with more than 8 years experience in health services research. Margaret is currently completing her PhD and is from the local area. For more information visit: www.kcl.ac.uk/iop/depts/hspr/research/ cemph/latest/index.aspx
Blog Spot FEATURED BLOG FROM VERITY ANN BUCKLEY
BETWEEN AN EDUCATED ROCK AND AN ACADEMIC HARD PLACE I don’t think I’m the first postgraduate student to have an inkling of fear about my future creep up on me day by day. Nor the last, I suppose. It’s quite difficult to describe this feeling. I am lucky to currently be enjoying a period of relative calm; a time of stability academically, financially and professionally. I should feel pretty good about things and most of the time I do. But the back of my mind houses a panic-stricken voice, screeching and crying about the hard road that lies ahead of me. That voice is becoming rather a pain. You see, the contract at my paid job ends relatively soon and although it will give me the time to finish my dissertation, I fear that it will end up acting as a springboard into the dark, dark void that is indefinite unemployment. I have friends who have finished their undergraduate degrees to find that no employer in their academic field is willing to touch them. Massive competition and lack of experience seem to be the biggest problems, alongside the presumed inability to apply academic knowledge in practical manner. I am, geographically, in the best place to find a graduate position apparently but that offers little consolation. Postgraduates also face these issues. Now, I’m one of those postgrads who went straight into an MSc after I completed my Bachelors. This is opposed to those who took a step on the career ladder first, and took a Masters alongside (or in between) their current job (clever sods). Luckily, I had work and volunteer experience under my belt but nothing that was academically akin to my (hopefully) future profession. Nevertheless, I have managed to put off these worries for quite a while, at least while the bulk of my studies lay ahead of me. That time is shortly due to pass. I’ve been examining my options a lot lately; when I graduate I will have an MSc in War & Psychiatry. My dissertation looks at psychiatric disorders (or lack thereof) in post-conflict society, using a case study of the Ivory Coast. I’m not sure what classification I will get, fingers crossed for a merit or above, of course. I have volunteer experience working with academic refugees as well as paid experience as an assistant for a team working on projects all over the world. I’ve met and worked with people from so many backgrounds and am desperately trying to boost my language skills to further improve my CV. Yet, I can’t help but think that I’ve painted myself into a corner. My work experience presents me as an office assistant. Although I’ve written a great many essays and conducted my own research, I am by no means a professional. Not even close in fact. I’ve been taking a look at a lot of jobs that are on offer in my field, within realistic boundaries of course. Ideally, I have been thinking I would like to find a position as a research assistant working with mental health in post-conflict society. Or just research generally related to this area. The problems immediately begin to arise. First of all, both my degrees are a little niche. My first degree was in Counselling Psychology and my second is in War & Psychiatry. I am neither trained as a counsellor nor a mental health specialist. My passion lies behind the scenes; I want to be in the shadows so to speak. I want to look at the work that’s going on now and to see if it’s successful or not. I want to evaluate current procedures and to conduct research that compares psychology across multiple cultures. Experience, they cry! You have no experience! It’s true. I don’t have any experience. But I know I can do this kind of work. It’s so frustrating to have this strong conviction of my abilities and, of course, my passions. I really don’t know what employers are looking for. The fact that larger organisations rarely give any feedback doesn’t help. I know this is a long road. I also know that I’m one of the lucky ones; I’ve been offered the chance to work on at least one paper with the hope of it being published. This could take quite a while, at least a year I imagine but not everyone gets a chance like that. The field is so competitive and I know that this paper will allow me to start edging forward. It’s getting harder and harder to know how to stand out from the crowd. How is anyone supposed to juggle everything that employers demand? I’m not being ungrateful, I know I must sound moany and annoying (imagine what I’m like in person!) but I truly do feel like I’m stuck between the proverbial rock and hard place. On one side, I’m doing well academically and am a strong and very capable student. On the other, I’m a novice to the professional psychiatric field and simply haven’t been around long enough to gain the experience needed to find the job that I crave. But patience is a virtue I suppose. If I am forced to take on a job that doesn’t quite fit the bill then I will have to do so. My CV is actually rather colourful, it wouldn’t hurt to add a few more surprises in there I guess. Until then though, I’ll be breaking out a hammer and chisel in an attempt to chip my way out of this canyon. Read more from Verity at http://warslikeglaciers.wordpress.com/ The Looking Glass | 15
EDITORIAL The Art of Communication
There was a time, not so long ago, in which the public were happy to blindly accept the pronouncements of scientists. Scientists were the wise, bearded men in white coats, perceived as experts with knowledge that is inaccessible to non-scientists and therefore they often went unquestioned. This is no longer the case. With the 21st century developments in technology large proportions of the population now have access to the internet and 24 hour news channels, both at home and on the move. This means that people are able to access and share information in a way that was not possible before, leading both to an increased awareness of political and scientific issue and the potential to engage with such issues in new ways. Not only can people find information regarding any number of topics via an internet search should they wish to carry one out, they are also able to share their
own stories or knowledge and communicate with like-minded people from across the globe. It is also true that as a society we rely on science and technology more than ever and so issues within these fields are often intrinsically important in the public arena. There are several approaches as to why it is important that science is communicated well. Normative approaches suggest that it is simply the right thing to do within a democratic society, whilst an instrumental view would acknowledge the interests served by good communication. The latter might include companies engaging potential customers in order to produce a product from scientific or technological innovations. Lastly, a substantive view engages the public in order to provide scientific solutions that are socially sound, thereby improving decision making. The public view is used to inform decisions but not simply to produce a marketable
product. For these reasons, the ability to communicate science and to do so well is incredibly important. There are several important factors that should be considered when trying to communicate science, whether it is in written form or some other medium. Science communication needs to be aware of its audience and accessible. In some cases it is directed to the layperson, and so the explanations of problems, hypotheses, methods and findings must be given in ways that a person without scientific training could understand. Of course, ensuring your audience can understand should not mean that the accuracy of the science is lost. Being able to ensure understanding and avoid ‘dumbing down’ or describing science in ways that are just wrong is important. One of the issues that arise within science communication is the way in which it is reported in the media. There might be a variety of reasons for the sometimes shoddy reportage of science in the mainstream newspapers. Amongst these, the fact that journalists need to sell a story is the most obvious. A catastrophic headline, delivered with absolute certainty is likely going to sell more than one in which new findings are cautiously reported in a more measured manner. In addition, journalists may not be trained in science and so don’t have the background knowledge required or may not
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EDITORIAL be trained in science and so don’t have the background knowledge required or may not understand certain mathematical or statistical concepts for example those relating to risk. On the other hand, the blame can’t simply be placed at the door of journalists; many scientists don’t know how to engage the public with their research, don’t talk to journalists or may not work with journalists in the most productive manner. Scientists and journalists have a joint responsibility to ensure science is reported correctly but in an accessible and engaging manner to the public.
Some companies have recognised the sometimes sloppy reporting of science and the dangers of it. For example, Sense about Science is a London-based charity, which carries out a number of activities to try to monitor, question and improve the nature of science reporting and public understanding of science in the UK. One such activity is compiling a database of scientific experts across a broad range of topics who
can be contacted when journalists wish to write an article on their area of expertise. The training and encouragement of early career scientists to engage with the media is another. Of course, there are various other organisations that work in similar ways and university press offices are generally the first port of call when a researcher has findings likely to be of public interest. Communicating any kind of science needs to be carried out well but some unique ethical issues arise when considering neuroscience and psychiatry. Often the issues involved are directly applicable to people’s lives. They might relate to the everyday choices people make about how to behave and thereby may affect the rules people live by. In addition, they might affect the perception of people who live with mental illness in a negative way, leading to discrimination or misunderstandings about their experiences. Furthermore, the nature of causal pathways in psychiatry and psychology are complex and public notions of causation may not account for this. For example, recent news stories suggested drinking fizzy drinks caused depression. Of course, those epidemiologically trained will understand that a link between the two may have been shown but that there could be numerous explanations for this. For one, it may simply be that depressed people drink more fizzy drinks because the sugars in them give them a boost (reverse causation). More complicated explanations may involve the health behaviours of individuals. Simply put, the case is not simple. However, when reported in the press these subtleties are seldom considered.
communicate science, not just to the academic world but also to the general public. We hope that this magazine will provide a platform from which these skills can be developed and honed. Of course, writing is just one way of communicating science. For the interested and creative, there is a multitude of ways to get involved. One thing is certain. The image of a professor in his office, surrounded by papers scrawled with indecipherable symbols and scribblings that only they understand is outdated. The modern image of a scientist is someone engaged with the public, informed about current affairs, charismatic and influential. If you want to work in science and you want to make discoveries that influence policy, healthcare or day to day issues that affect people’s lives you will have to spend some time communicating your work to various audiences. Learning these skills early on is therefore a worthwhile task. Rhianna Goozée
This is why it is important for early career scientists to learn how to
YOUR LETTERS AND OPINIONS Write to us at iopmag2012@gmail.com to let us know what you think about the magazine or to respond to articles. You can also use our Facebook page to post comments and opinions.
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enough expertise unless you focus.
On the Couch with…
For non-clinicians, I guess you need to have a system or a technique that other people don’t know. You want to be somebody to whom others will come because you have an expertise that they don’t have. So to some extent it’s quite good to go away. If you just stick around the IOP and learn what everybody is learning from the same lot of people, it’s much more difficult to do anything highly original because Phil McGuire or Sukhi Shergill have already thought of it and discarded it as a dumb idea.
Professor Sir Robin Murray
On a bright December afternoon, I made my way up to the seventh floor of the IOP, where the winter sun shone in over a rather lovely view of South London, to the office of Professor Sir Robin Murray. Both a familiar face and name around the Institute, I sat down to talk with Robin Murray about his career, the big unanswered questions in psychiatry and what he would have done if he hadn’t become a clinical researcher. So, you started out training as a psychiatrist, what made you move towards research as opposed to concentrating primarily on clinical work?
chosis and obviously the reason for that was, in the 1990s, we kept seeing more psychotic people who were taking large amounts of cannabis. It’s not something that I guess because in psychiatry I had a great flash of genius there are so many things that about! clinicians believe that are uncertain or probably wrong, Or to think of another area – so I was interested to know I am interested in psychosis what you can believe and in immigrants. But, for any what was just handed down clinician who works for by dogma or by authority. SLAM, you’d have to have half a brain not to think this You still work clinically, for was relevant. part of your time, how important would you say that So, I think, for my kind of that is work in informing research, it’s been important your research? to work clinically. Well, I’ve always been a clinical researcher so the things that I do are often related to issues that I’ve noticed in the clinic. For example, I’m interested in cannabis and psy-
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It’s fair to say you’ve had a very successful career and there are lots of people reading this that are just starting out on theirs. What advice would you give some-
There have been lots of political and social changes throughout your career, how do you think the research environment has particularly changed, especially given the recent economic downturn? Do you think that has this significantly impacted the research environment people are working in today?
one just starting out who Well, when I started doing wants to have an academic research, there was a huge gap between neuroscience career? and the clinic. There was no Well, you need to find some decent imaging and no deway of differentiating your- cent genetics and little epideself from everybody else. So miology in psychosis. So from if everybody is doing re- a scientific point of view, the search into one particular developments in neurosciarea, this area is obviously ence and the developments going to be more competi- in genetics and, also, the detive and your work less no- velopments in social science ticeable. So it’s better to de- have all meant that they can velop a particular expertise feed into research in psychiadifferent from everybody try in a much more productive way. So, from this point else. of view I think things are I think for clinicians it’s good much better. And also when I to specialize. For example, started there was a lot of it’s silly to try and do re- acrimonious dispute besearch across general medi- tween biological researchers cine, you have to be an ex- and psychoanalysts and, by pert in renal disease or be an and large, psychoanalysis has expert in chronic pancreatitis been replaced by more rabecause otherwise you will tional psychological models. never see enough patients So, all these things are very with a disorder for you to get healthy.
“I’m particularly looking forward to see “post -vacation dysphoria” make it into DSM” In terms of research moneys, it is difficult just now but it is not half as difficult as it was in the 1980s, when I was Dean of the Institute. For much of Mrs Thatcher’s period the universities were being squeezed badly. So although things appear bleak right now we started from a much higher base and I don’t think people should be hopeless. The research environment at the Institute has improved and there are still lots of options; for example one can apply for European or American grants. As you mentioned there has been an increase in collaborative research and new have been made but there are still lots of unanswered questions despite progress in psychiatric research. What would you say is the most interesting unanswered question within psychiatry? Well, by psychiatry, I usually mean psychosis because I really don’t know very much about depression or anxiety. However, I think probably in this instance the same applies across psychiatry. We
know that there is a genetic component to psychiatric disorders (which has probably been overstated in the past) and we know there are lots of environmental factors but they’re not very specific. So I personally think the most interesting issue is what is the nature of the gene-environment interaction that determines why one person will react to some adversity by coping with it and another by becoming depressed and another becoming psychotic? These are the things that interest me most at present.
illness category. So, I totally agree that American psychiatry tends to extend into normal everyday life and create conditions where none existed before. I’m particularly looking forward to see “postvacation dysphoria” make it into DSM for the feelings you have when you come back from holiday! I’m sure there will soon be a whole class of drugs for it – “returnolytics”. So one can see it happening. The pharmaceutical industry certainly in the past has tried to create conditions for which they could find drugs to work. I’m rather interested in a dimensional model but the problem with a dimensional model is where does it stop? One can imagine pharmaceutical companies wanting to give medications well into the normal range.
In this issue we are featuring a debate and an article considering whether the Western medical model tends to pathologise human suffering. What would your view be on that? Do you think that the Western medical model does tend to pathologise normal states and so extend Given the success you have the boundaries of mental achieved, what would you say is the achievement you illness too far? are most proud of in your Well, of course, there is not career so far? just one Western model. However, I think that the Oh, well the most important American model, which is thing that I have done is out really a Capitalist model, on the wall out there, does do that because the [indicating pictures of those American Psychiatric Associa- he has worked with], all the tion wants psychiatrists to be people that have worked for well paid and for them to be me and who have gone on to paid to see a patient then the be professors or famous repatient has to be given an searchers or kind clinicians.
It’s not that difficult to be a professor at the IOP because all you have to do is to scan the smart young people passing by and then grab one and give them some half-baked idea, which they will convert into a PhD and publish great papers on it. So I think what I am most proud of is training people and getting people interested in research, and hopefully staying friends with them! Research is fascinating, it’s like a sort of detective story and so if you can get interested in it that’s very sustaining. For clinicians, you know, it’s quite hard to see patients from 9 o’clock on Monday morning until 5 o’clock on Friday afternoon right through every week. If you can think about the conditions or be curious about them and develop a special area of interest it’s very helpful. For non-clinicians, there’s no point doing it unless you find it fun. So I think it’s the researchers I’m most proud of. Lastly, if you hadn’t been a clinical researcher, what alternative career would you have chosen? I wanted to be an architect but I cannot draw. That’s what I was most interested in but it was hopeless!
Scottish psychiatrist Robin Murray trained in medicine at the University of Glasgow and began his psychiatric work at the Maudsley in 1972. Apart from a year spent in the USA at the National Institute of Mental Health in 1976, he has worked at the Maudsley and Institute of Psychiatry ever since. He has held various posts here including Dean of the Institute and Professor of Psychiatry. Further afield he has served as President of the European Association of Psychiatrists, had a Research Unit at the University of Sao Paolo named after him and is a Fellow of the Royal Society. He is also a co-editor-in-chief of Psychological Medicine. Between 1997 and 2007 Thomas Reuter’s Science Watch ranked him as the 8 th most influential researcher in psychiatry and 3rd within schizophrenia research. He is a high profile researcher with his research featuring in the news on several occasions, his public disagreement with David Nutt over the dangers of cannabis and its links to psychosis featured in The Guardian in 2009 and appearances on programmes such as Panorama.
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Call for submissions! The Looking Glass needs you!
We need submissions for Issue 2 and beyond! If you have enjoyed what you’ve read and want to be part of it, you can contribute any of the following:
•Articles relating to psychiatry or psychology; •Reviews of books, films or music with a psychological theme; •Have you attended an event that you want to tell us about? We also happy to receive comments, feedback and suggestions for future interviews. Alternatively, if you know of events, schemes or research going on at the Institute or across London that might interest our readers feel free to get in contact.
Contact us at iopmag2012@gmail.com You can also like our Facebook page to keep updated with what’s going on at The Looking Glass, detailed submission criteria and more. Just go to: www.facebook.com/TheLookingGlass2012
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Submissions guidelines for ‘The Looking Glass’, the IOPs student publication If you are a Master’s student, a PhD student or an early careers research worker then we are looking for submissions. You can contribute:
A feature: 1000 – 2500 words
A review: We are also interested in short book reviews (250 – 500 words) and reviews of films or music (around 500 - 750 words).
All articles should be relevant to the psy-fields (human mind and behaviour, history of psychology or psychiatry, abnormal psychiatry, world mental health,…) We like to encourage debate and the sharing of ideas. However, we will not publish sexist, racist, homophobic or any other kind of discriminatory content.
The Looking Glass is a magazine NOT a journal and contributions should reflect this. Aim for a magazine article and not an academic paper, avoid too much technical language or too many footnotes. Work references into the body of the article and try to make it readable.
Your work must be your own, original and unpublished.
We don’t want to restrict your creativity. If you have an idea for content that doesn’t necessarily fit the above categories you can always check with the editor before you write it by emailing iopmag2012@gmail.com.
If your article is related to current unpublished research ensure you have permission to write about the research and that you cite the appropriate people and/or research teams.
We don’t currently have a standard deadline for submission but the earlier you submit in the preceding month before the issues are published, the more likely it is your article will be included.
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CONTRIBUTORS
Editor Rhianna GoozĂŠe
Assisting editors Analucia Alegria Dr Andres Herane Vives Dr Jorge Palacios
With thanks to Emma Palmer Claire Bithell The Association of British Science Writers Emma Quinlan Dr Derek Summerfield Dr Abedaw Fekadu Prof. Graham Thornicroft Derek Andrews Tytus Murphy Verity Buckley Prof. Sir Robin Murray
Thanks to all those who helped to support us in producing the first issue.
The Looking Glass
Original art and photography on pages 2, 3 and 10 are the intellectual property of Rhianna GoozĂŠe. Please ask for permission to reprint in any format. Other art and design property of Microsoft Office Inc.