November 2013

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psychologist vol 26 no 11

november 2013

Mind the gap – pathways to psychosis Helen L. Fisher explores links between childhood maltreatment and adult psychosis

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letters 778 news 786 careers 826 new voices 840

renewal of ethics 802 siblings and mental illness 808 interview with Richard Byrne 812 looking back: self mutilation 842

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Contact The British Psychological Society St Andrews House 48 Princess Road East Leicester LE1 7DR tel 0116 254 9568 fax 0116 227 1314 mail@bps.org.uk www.bps.org.uk www.twitter.com/bpsofficial

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psychologist vol 26 no 11

letters 778 responses to austerity; work capacity assessments; psychology graduate job market; anorexia and autism; and more 786 news and digest best practice research recommendations; dementia screening; BRAIN Initiative; video games and violence; reports from the BPS/British Association Lecture, CogDev 2013, Division of Health Psychology conference; and more SUSAN WILKS/WWW.SWILKS.COM

Mind the gap – pathways to psychosis Helen Fisher explores links between childhood maltreatment and adult psychosis

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A renewal of ethics Mark Burton provides an action framework for responding to contemporary crises

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Rethinking siblings and mental illness Christopher Griffiths and Jacqueline Sin offer support for the brothers and sisters of people affected by mental illness

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Interview: Out of Africa Richard Byrne tells Lance Workman about his work with apes and elephants

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THE ISSUE ‘The child is father to the man’ wrote William Wordsworth. Of course, he was writing about himself and how his delight in seeing a rainbow as a grown man was the same for him as when a child. The deeper meaning is that our adult personalities are formed in childhood. But there is perhaps a darker meaning too.

Maltreatment in childhood has been shown to be one of the risk factors for psychosis in later life. Helen Fisher’s article ‘Mind the gap’ (p.798) examines the various candidate mechanisms that might be involved in this association.

In our September issue we brought together several contributions on how the current austerity climate is affecting how psychologists research, teach and practise. The austerity theme is continued and widened in this issue, not only with letters in response but also with Mark Burton’s article (p.802) appealing for a renewal of the ethical basis on which psychology is practised. Austerity will be with us for some time to come, so the politicians warn us; we will accordingly continue to explore the psychological implications.

Peter Dillon-Hooper Acting Editor

society 816 President’s column; Book Awards 2013; engaging with politics in Northern Ireland; communicating psychology to the public through dance; Division of Health Psychology awards; and more

reviews 836 the usual mix of book reviews and other media reviews, including a review of the ‘Thinking with the Body’ exhibition at the Wellcome Collection

826

looking back 842 ‘An emotional but ill-ruled machine’: Sarah Chaney on how late 19th-century psychiatry interpreted and explained self-mutilation

careers and appointments

we talk to Peter Mitchell about teaching psychology in Malaysia; and to Lucy Standing on the working options for occupational psychologists, and on her role as a social entrepreneur

new voices 840 imagining our future… and changing it: Scott Cole with the latest in our series for budding authors

one on one

844

…with Maryon Tysoe

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LETTERS

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Moving forward from austerity

contribute

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

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

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

The familiar sensation of excitement

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and urge for action overcame me when I read Mr Anderson’s manifesto.

I enthusiastically endorse his first point.

I would argue that within any service,

it is possible and desirable to ‘strive for a more authentic practice’ by acknowledging additional causes for distress beyond individual factors.

It is very welcome to see The Psychologist, the monthly voice of members of the British Psychological Society, making a space for members of the Society to address critical issues raised by ‘austerity’ (‘Austerity psychology’, September 2013).

After all, even the Chief Economist and Deputy Secretary-General of the Organization for Economic Cooperation and Development has conceded that ‘austerity programmes…can add to the woes of already struggling economies, leading to more

job losses and social hardship’ and ‘worsen’ inequality, all of which are interconnected with the work of many members of the Society and, as the contributors point out, ‘psychology has lagged behind other disciplines in trying to understand these connections’, so this initiative is very welcome.

It is also welcome that the six responses from community and clinical psychologists, when asked whether ‘these troubled times’ have an impact on how Society members ‘research, teach or practice

psychology’, responded by unambiguously positioning proximally preoccupied, individualistic, decontextualising, victimblaming, oppressive, masculinist, neo-liberally managed enacted versions of the discipline, i.e. the currently dominant versions, as thoroughly problematic.

It is also welcome that the six responses asked critical questions about whose interests are served by what is thought, written and done by psychologists and what the implications are of various

These pages are central to The Psychologist’s role as a forum for discussion and debate, and we welcome your contributions.

Send e-mails marked ‘Letter for publication’ to psychologist@bps.org.uk; or write to the Leicester office.

Letters over 500 words are less likely to be published. The editor reserves the right to edit or publish extracts from letters. Letters to the editor are not normally acknowledged, and space does

positions taken up by psychologists for the empowerment of some and de-powerment of other interest groups.

What would be even more welcome would be more radical critique. The six responses: (i) problematically position ‘austerity’ as ‘a psychological issue’; (ii) reinscribe the ‘reality’ of ‘psychological states’ such as ‘distress’, ‘depression’, ‘anxiety’, ‘psychological illhealth’ ‘and other mental health problems’; (iii) position such psychological states as

not permit the publication of every letter received.

However, see www.thepsychologist.org.uk to contribute to our discussion forum (members only).

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TIM SANDERS

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

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

His third point was perhaps the most disheartening – because, I think, I agree with it so much. I want to ‘make judgements that directly influence the material quality of people’s lives’. I really do. On placement in a deprived part of Milton Keynes, I felt ashamed and powerless in the face of financial and social deprivation.

understandable and preventable through a psychological science of cause and effect; (iv) position ‘power’ as a phenomenon a psychologist can ‘have’ and that psychologists are able to redistribute through ‘empowerment’ ; (v) position austerity as an ‘opportunity’ to ‘move psychology towards practising at a wider systems level’, for the Society to, institutionally, give a ‘strong professional lead’, a stimulus to ‘strengthen’ psychologists’ ‘professional identity’; and (vi) position austerity as an ‘opportunity’ for psychologists to, individually, advance their sectional interests, conspicuously demonstrate principled solidarity and contest the new public management of psychology in practice.

In taking these positions,

But I didn’t know what, if anything, I could do about it. I reflected on it with peers and in supervision, but no one knew, although everyone acknowledged the role of inequalities.

Inequalities exist. They cause distress. And I want to do something about it. This is why I feel enthusiastic about the philosophical approach of community psychology. But along all the abstract nouns, I miss the specifics.

Perhaps it’s because I am a trainee, and as such I am used to being shown how to do things, and I don’t (yet) feel confident creating new ground. Or perhaps the sentiment that community psychology is easy to agree with and hard to do is common among other psychologists.

So here is a suggestion. Perhaps The Psychologist could offer Mr Anderson (or

the responses problematically reinscribe a version of the psycomplex (‘the heterogeneous knowledges, forms of authority and practical techniques that constitute psychological expertise’: Rose, 1999, p.vii) and thus underline the need to engage in critique of the frame of reference of the discipline rather than engage in critique within that frame of reference.

In particular, although appearing to critique austerity and thus neoliberalism, in reproducing the psy-complex, the responses simultaneously reproduce the means of re-

read discuss contribute at www.thepsychologist.org.uk

other community psychologists) a column where they could describe specific ways in which they worked towards their goals. A ‘no-excuses, howto guide’ for aspiring community movers, if you will. Perhaps this could help me and others like me feel empowered to take our enthusiasm for social change away from the dinner party table and into the community – where it belongs.

Mareike Suesse Trainee clinical psychologist Oxford Health NHS Foundation Trust

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

vol 26 no 9

september 2013

Austerity psychology Is the economy affecting how you research, teach or practice?

10 years of the Digest 630 euro congress 636 careers 680 looking back 696

Incorporating Psychologist Appointments £5 or free to members of The British Psychological Society

swearing – language of life and death 650 anorexia and the autistic spectrum 656 no voice, no choice 660 interview with Oliver Sacks 664

subjectification of citizens to render them self-managing within neoliberal forms of governmentality. That such re-subjectification has already been achieved in the case of some at least of the authors of these responses is already indicated by the suggestion that ‘training in economic analysis’ should be incorporated into ‘research

methods curriculum at undergraduate and post graduate levels’ so they are ‘not only…required to consider what works, but at what cost’. As Chris Lorenz (2012, p.603) has pointed out ‘market fundamentalism is…the very core of neoliberalism’ at the heart of the take-over of higher education by New Public Management.

David Fryer Rose Stambe University of Queensland Brisbane References Lorenz, C. (2012). If you’re so smart, why are you under surveillance?

Universities, neoliberalism, and new public management. Critical Inquiry, 38(3), 599–629.

Rose, N. (1999). Governing the soul (2nd edn). New York: Free Association Books.

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

First, evidence not reviewed by Allely shows that atypicalities common across conditions (e.g.,’ emotional theory of mind) are present largely during the active, rather than during the recovery, stage of AN (e.g. Oldershaw et al., 2010), suggesting that such atypicalities are likely to be a secondary consequence of starvation, not a fundamental feature of AN. These findings echo similar discussions almost two decades ago regarding the potential overlap between AN and another set of conditions, personality disorders (PD). Just like in the emerging AN–ASD literature, researchers in the 1990s reported signs of PDs (e.g. impulsivity, affective instability) in individuals with disordered eating – but, again, these features abated following

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recovery. Indeed, after a decade of research, the authors of one meta-analysis concluded that ‘researchers and clinicians must exercise caution when assessing and diagnosing PDs during the active phase of an eating disorder’ (Cassin & von Ranson, 2005, p.909). It would be wise for researchers and clinicians interested in the AN–ASD overlap to heed the same warning.

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

Understanding the nature of the AN–ASD link is critical for understanding precisely how to intervene in both conditions. The eating disorder field offers decades of empirical evidence for the

efficacy of a variety of interventions (e.g. Wade et al., 2011) that already work to target ASD-like characteristics such as rigid thinking. It will be important to understand the potential moderating influence of ASD-like traits on AN individuals’ responses to such interventions. We believe, however, that the possibility that treatment approaches to AN could all benefit from a neuropsychiatric developmental disorder approach may well be an overstatement.

Rachel Hiller Clinical PhD candidate Flinders University, South Australia Liz Pellicano Director, Centre for Research in Autism and Education, Institute of Education References Baron-Cohen, S., Jaffa, T., Davies, S., et al. (2013). Do girls with anorexia nervosa have elevated autistic traits? Molecular Autism 4(1), 24.

Cassin, S.E. & von Ranson, K.M. (2005). Personality and eating disorders: A decade in review. Clinical Psychology Review, 25, 895–916.

Odent, M. (2010). Autism and anorexia nervosa. Medical Hypothesis, 75(1), 79–81.

Oldershaw, A., Hambrook, D., Tchanturia, K. et al.

(2010). Emotional theory of mind and emotional awareness in recovered anorexia nervosa patients.

Psychosomatic Medicine, 72(1), 73–79.

Wade, T.D., Treasure, J. & Schmidt, U. (2011). A case series evaluation of the Maudsley Model for treatment of adults with anorexia nervosa.

European Eating Disorders Review, 19(5), 382–389.

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

The article ignores this important development and it is possible to argue that the practice of educational psychology owes as much to the academic study of education as it

does to psychology. Indeed, in the United Kingdom, before 1944 the majority of professors of education were psychologists.

At the same time their universities were often indifferent to opening psychology departments.

The impact of these professors on professional practice can be shown by naming a few of them: C.W. Valentine at Birmingham 1919–1946, Sir Godfrey Thomson at Newcastle 1920–1925 (later Edinburgh), Dame Olive Wheeler at Cardiff 1925–1951 and Cyril Burt at the London Institute of Education 1926–1932. Also at the London Institute was Susan Isaacs but never a professor. It is hardly surprising given the psychology taught in many education departments that some like Birmingham and Swansea became providers of training courses in educational psychology.

Professor J.B. Thomas FBPsS Loughborough University

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Pain of work capacity assessment I was pleased and inspired to read Dr and often it will undermine all the useful find that our concerns fell on open ears Hayley Entwistle’s letter (‘Softening the work they have done, or could have done, and a number of positive steps were impact of welfare change’, September with pain management. It brings to mind taken. Dr Martin Johnson, Clinical 2013). I read with interest previous letters Maslow’s hierarchy of needs – if someone Champion for Pain at the Royal College on the subject of the welfare changes and is focused on how they will keep a roof of General Practitioners, agreed to take how they impact our client groups (e.g. over their head and feed their family, then the issue further via The Patients’ ‘Can we be lobbyists for social change?’ they are not going to be in a good place Association. Dr Beverley Collett, said that from Jade Weston and Nic Horley, April for psychological work. In some cases the she would raise it with the Chronic Pain 2013). Like others, I believe that we financial, psychological and social fall-out Policy Coalition. A colleague and I were should use our influence as health is enough to tip clients into suicidal asked if we would write an article for Pain professionals to advocate for our clients. ideation and planning, or other selfNews, which we duly did (Jenkins & This is not to deny the point made in defeating behaviours. Most of my clients McGurk, 2012). Our article produced another letter that in some cases we see end up going through a stressful and some interesting responses, including a clients who twist the system letter from a retired consultant to their own advantage who decided that he could (‘Lobbying for social change’, make a positive contribution May 2013, name and address by sitting on the panel for the supplied). However, to get tribunal hearings thereby too much into this debate bringing a much needed blurs the main issue, which specialist knowledge of chronic is not about whether any one pain to a process which had individual deserves welfare hitherto neglected this. support but rather whether Perhaps this is something that the system allows a fair psychologists might consider assessment of their situation. doing (if they are not already)?

I work in a community Recently the government chronic pain team, and for commissioned a fourth the last few years the topic independent review of the of the Work Capacity WCA system, to be led by Dr Assessment (WCA) has Paul Litchfield. The deadline dominated much of my for submissions to the review clinical time. Since Atos were was 27 August 2013. The brought in to perform this British Psychological Society assessment, many people attempted to coordinate who were previously deemed a response, but unfortunately unfit to work due to a did not get enough of a chronic pain condition have comeback from members been told that they are to make it worthwhile. I for capable of work and that one certainly did not see this they will lose their benefits consultation in time, and if they do not comply. I have I suspect that others also no problem with the stated missed it. My personal logic behind the welfare correspondence with the BPS reforms; however, the Policy Team reveals that they assessment system has to be are concerned that these The assessment system has to be fair and fit for purpose, and fair and fit for purpose, and consultations are not reaching unfortunately this is not what we are seeing unfortunately this is not enough members and they are what we are seeing. currently developing new ways The WCA is inappropriate for people prolonged appeal and tribunal, and of distributing them. It is a shame that with long-term health conditions, where in many cases the original decision is on this occasion we missed this chance the amount that they can do varies eventually overturned and they are once to speak out and influence the shaping considerably from day to day and where again deemed unfit to work. It is of what will hopefully be an improvement they experience ‘pay back’ (prolonged infuriating to watch this process, and on the current situation.

Dr Rhona McGurk periods of increased pain or fatigue) if one wonders about the cost both in Solent NHS Trust they push themselves beyond their human terms and financially. current level of tolerance. I see at first After being repeatedly confronted with Reference hand the effects of the WCA. The shock, this scenario, I got together with a group Jenkins, A. & McGurk, R. (2012). What’s the benefit? fear, anger and helplessness that my of colleagues to see whether there was The impact of the overhaul to the benefits system clients experience as a result of this anything we could do. We decided to on chronic pain patients – Should we be doing process is hugely detrimental to the approach the council of the British Pain anything about it? Pain News, 10(4), 239–240. management of their health condition, Society and were refreshingly pleased to

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

In my experience as a chronically underemployed psychology graduate, the points made by Newby and his colleagues reflect the views of very many recruiters, not just senior psychologists appointing staff.

Unfortunately, these views reflect a failure to appreciate the circumstances in which graduates apply for jobs, as can be indicated by responding to the three major points made by Newby and his colleagues.

First, application forms with supporting documents

can take many hours to complete.

At the same time, there are pressures for the unemployed in particular to apply for large numbers of jobs.

Moreover, if there are over two hundred applicants for a job, aspirant employees can be confident that they will be rejected. In these circumstances, it is unsurprising that people completing forms use generic techniques, such as ‘cut and paste’, and that they fail to check the quality of their

applications adequately in terms of spelling and grammar.

Second, people invited for interview should of course have the courtesy to notify the panel if they are unable to attend. But the whole culture of the recruitment process has

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become one of noncommunication. Employers routinely fail to let applicants, even ones who have completed lengthy and complex forms, know that they have been unsuccessful.

By this standard, why should applicants tell employers that they no longer wish to be considered?

Third, once an applicant has got as far as an interview, it obviously makes sense to prepare by collecting information about the job.

However, the time that candidates have to ‘swat up’ is often limited, particularly if they are lucky enough to have several interviews on consecutive days.

The problems that Newby and his colleagues report are symptomatic of a job market

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2 Send your entry (photocopies accepted) marked ‘prize crossword’, to the Leicester office (see inside front cover) deadline 2 december 2013. Winner of prize crossword no 71 Andrew Coleman, Leicester no 71 solution Across 1 Doorknob, 5 Staged, 10 Scarlet, 11 Upstate, 12 Grey matter, 13 User, 14 X-rated, 17 Mignon, 19 Ordeal, 20 Nailed, 23 Neck, 24 Assailants, 28 Placebo, 29 Fechner, 30 Cohere, 31 Blustery. Down 1 Dosage, 2 Orate, 3 Kilometre, 4 Octet, 6 Test, 7 Gladstone, 8 Dreary, 9 Superman, 15 Rorschach, 16 Delusion, 18 Gridlocks, 21 On spec, 22 Osprey, 25 Awful, 26 Nonce, 27 Tear.

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that is fundamentally broken.

In other letters in the October 2013 issue of The Psychologist, both Lisa Molloy and Francis Harkness refer to the psychological harm done by over-competitive job seeking.

Conversely, the plethora of job applications wastes huge amounts of recruiters’ time, which would be better used to provide much needed services to clients.

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

Government procedures originally developed, using advice from occupational

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

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

Frederic Stansfield Canterbury

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Do rethink about American psychologist (9) A state university’s winegrowing area (5) Hide discharge (7) Long English film (4) Refusal after ignoring initial ousting (8) Church men let out laugh (7) Popular opinion on case (8) Some generosity shown with love instinct (4) A quiet father, say, it’s clear (8) Feeling of pity when concealing information on causes of disease (9) Flags nothing to me – dull! (8) God of dreams heading off with legendary poet (7) Down payment is picked up in store (7) Thus mother’s body, as opposed to psyche (4) Regarding everyone returning to plain (5) Fixed, say, with diplomacy (4)

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1 Refer nascent alteration to describe displacement (12) Ambition may be thing I’ve shown (9) Depressant initially discarded by proprietor (5) Queasy feeling shown by number with alcoholics concealing use (6) Regulations of conditions housing workers (8) I’m a long time taking pictures (6) Weaponry endlessly deployed before quiet sleep (5,3) Transport Oahu pier about (8) These days, let off steam on arrival (6) Moral reservations about old weight units (8) A vote taken on old moon mission (6) Chap meets bridge opponents in clerical home (5) Test platform of early psychosexual development (4,5) Fancy large shelter with reserves backed by promissory notes (12)

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Sheila M. Chown (1931–2013) Sheila Chown (née Sawyer) was born in London and educated at Cheltenham Ladies’ College. She entered Bedford College London to read psychology, achieving a first class degree in 1953.

Following graduation, she worked for a year at Rowntrees in York before embarking on a PhD on the formation of occupational choice in grammar school pupils, the degree being awarded by the University of Liverpool in 1959.

From 1956 to 1960 she was employed as a scientific officer at the newly set up Medical Research Council Unit on Occupational Aspects of Ageing. This involved large-scale surveys of manual workers in the manufacturing industry on Merseyside and the administration of psychological test batteries to older people drawn from a variety of sources, including military hospitals, adult education classes and over60s clubs. Sheila used to boast that she was one of the few people living who had carried out factor analyses ‘by hand’. In 1961 a vacancy occurred in her alma mater and she joined the staff of the Psychology Department, where she was to remain for the rest of her academic career. She was appointed Reader in Psychology in the University of London in 1973.

Sheila’s particular research interest was adaptation to change in relation to ageing.

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

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

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

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

Elizabeth Valentine Royal Holloway, University of London

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Mind the gap – pathways to psychosis Helen L. Fisher, the 2011 winner of the Society’s Doctoral Award, explores links between childhood maltreatment and adult psychosis There is reasonably consistent evidence that childhood maltreatment is associated with psychosis in adulthood. The focus of research has now shifted to the potential mechanisms that underlie this association. In a direct pathway, abusive experiences quickly result in psychotic or subclinical symptoms that persist into adulthood where they are diagnosed as a full-blown psychotic disorder. Alternatively, childhood maltreatment could affect an individual’s biology, psychology and/or behaviour and subsequently lead to the development of psychosis several years later.

Once these pathways have been elucidated, can clinicians provide timely interventions to prevent the emergence of psychotic disorders amongst maltreated children?

questions resources

Garety, P.A., Bebbington, P., Fowler, D. et al. (2007). Implications for neurobiological research of cognitive models of psychosis. Psychological Medicine, 37, 1377–1391.

Varese, F., Smeets, F., Drukker, M. et al.

(2012). Childhood adversities increase the risk of psychosis. Schizophrenia Bulletin, 38, 661–671.

references

A

What happens following maltreatment that leads children to develop psychosis when they become adults?

Alexander, P.C., Anderson, C.L., Brand, B. et al. (1998). Adult attachment and long-term effects in survivors of incest.

Child Abuse & Neglect, 22, 45–61.

Arseneault, L., Cannon, M., Fisher, H.L. et al. (2011). Childhood trauma and children’s emerging psychotic symptoms. American Journal of Psychiatry, 168, 65–72.

Asarnow, R.F., Nuechterlein, K.H., Fogelson, D. et al. (2001).

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national survey conducted by the NSPCC children’s charity in 2009 reported that one in four children in the UK were maltreated by their parents before the age of 17, mainly through neglect, and nearly two thirds were victimised by their peers (Radford et al., 2013). These shocking figures indicate that a substantial proportion of children in the UK are still exposed to abusive and neglectful experiences, and the consequences of these warrant investigation. Although many individuals exposed to childhood maltreatment (emotional, physical or sexual abuse or neglect) do not develop any major difficulties, they are at higher risk of developing a range of adverse outcomes, including substance misuse, depression, antisocial behaviour, post-traumatic stress disorder, and personality disorders, along with physical health problems. Therefore, it is not surprising that researchers and clinicians have begun to explore links with psychosis as well.

Psychosis is a broad concept characterised by symptoms such as hearing or seeing things that other people do not, being extremely paranoid, believing other people can read your thoughts, and disorganised thinking. It encompasses several diagnoses, including schizophrenia and depression or mania with psychotic features. The lifetime prevalence of all psychotic disorders is around 3 per cent (van Os et al., 2009), with schizophrenia affecting approximately one in a hundred people. This prevalence may be low but it still amounts to over 8000 new cases of psychosis in the UK every year. This has

Schizophrenia and schizophreniaspectrum personality disorders in the first-degree relatives of children with schizophrenia. Archives of General Psychiatry, 58, 581–588.

Beards, S., Gayer-Anderson, C., Borges, S. et al. (2013). Life events and psychosis. Schizophrenia Bulletin, 39, 740–747.

Bifulco, A., Brown, G.W. & Adler, Z. (1991). Early sexual abuse and

devastating effects on the individuals themselves, as well as their families who have to deal with the fall-out. Cruelly, psychosis often strikes in late adolescence when someone is just starting their first proper job or studying at university.

Although some affected individuals will recover fully, many will continue to be scarred psychologically and socially for the rest of their lives. Therefore, it is imperative that the causes of psychosis be ascertained so that clinicians can intervene early enough to prevent more lives from being tragically cut short.

Is there good evidence that children who are maltreated are at greater risk of developing a psychotic disorder? And given that psychotic disorders tend to emerge in early adulthood, what might be happening following exposure to childhood maltreatment that leads individuals to develop psychosis so many years later?

Link between maltreatment and psychosis Data from several longitudinal cohorts have shown that early adversity is associated with early psychotic experiences which are thought to be on a continuum with psychotic disorders (van Os et al., 2009). For instance, the Environmental Risk Twin Study found that children who had experienced physical maltreatment by a parent were at higher risk of having psychotic symptoms at age 12 than children not exposed to this form of adversity (Arseneault et al., 2011). The effect was even greater if the child had also been bullied by peers, and the association was only present for intentional acts of harm. Other general population studies have found associations over time between documented records of maltreatment and clinically relevant psychosis in adults (e.g. Cutajar et al., 2010). Childhood maltreatment has also been demonstrated to be more prevalent amongst patients presenting to services for the first time with psychotic disorders than among

clinical depression in adult life.

British Journal of Psychiatry, 159, 115–122.

Borges, S., Gayer-Anderson, C. & Mondelli, V. (2013). A systematic review of the activity of the hypothalamic-pituitary-adrenal axis in first episode psychosis.

Psychoneuroendocrinology, 38, 603–611.

Collip, D., Myin-Germeys, I., Wichers, M. et al. (2013). FKBP5 as a possible

moderator of the psychosis-inducing effects of childhood trauma. British Journal of Psychiatry, 202, 261–268.

Cougnard, A., Marcelis, M., MyinGermeys, I. et al. (2007). Does normal developmental expression of psychosis combine with environmental risk to cause persistence of psychosis?

Psychological Medicine, 37, 513–527.

Cutajar, M.C., Mullen, P.E., Ogloff, J.R. et

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Therefore, genetic factors could be confounding the association between maltreatment and psychosis. However, when parental history of psychosis was

Alternative explanations

reality, as well as comorbid depression and cognitive impairment, all of which could result in exaggerated or false reports of maltreatment. However, it has been found that patients with psychosis were reasonably consistent in their reports of abuse over a seven-year period, tended to report the same events when assessed with different measures, and were not more likely to report maltreatment when they were acutely psychotic or depressed at the time of the interview (Fisher et al., 2011).

Therefore, these findings provide some reassurance that reporting bias is not substantially affecting associations found between childhood maltreatment and psychosis.

SUSAN WILKS/WWW.SWILKS.COM

geographically matched unaffected controls (Fisher et al., 2010).

This research has culminated in a meta-analysis of all the different studies exploring the maltreatment– psychosis association (Varese et al., 2012), which found that the relationship was statistically significant regardless of the type of study design employed. Although a causal relationship has not yet been established, the evidence now overwhelmingly points to childhood maltreatment being a risk factor for the development of psychosis in adulthood.

One possibility given the wellreplicated association between childhood maltreatment and depression (e.g. Bifulco et al., 1991) is that cases of depressive psychosis are driving the association with psychotic Direct effects? disorder. However, a meta-analysis The immediate biological from Matheson et al. (2013) has consequences of demonstrated that this is unlikely childhood maltreatment to be the case as they found no provide one possible direct significant difference in the rates pathway to psychosis. For of maltreatment between instance, head injuries schizophrenia and depressive sustained from childhood psychosis patients. physical abuse can cause Another possibility is that the Longitudinal cohort studies have demonstrated that children brain damage, and when this association demonstrated between as young as 12 can report psychotic symptoms is sufficiently severe individuals childhood maltreatment and adult are highly likely to experience psychosis is merely an artefact psychotic symptoms (Kim, produced by a third factor that is 2008). However, the evidence to support independently associated with both controlled for in the analysis the this supposition is inconsistent and maltreatment and psychosis. For example, trauma–psychosis association held, requires further investigation. having a parent with psychosis provides suggesting that other factors must be It is also possible that some children a child with both the genetic susceptibility accounting for this relationship. who are maltreated have an almost to develop psychosis (Asarnow et al., Additionally, the use of retrospective immediate psychotic reaction to this 2001) and also increases their likelihood reports of maltreatment by individuals adverse experience, suggestive of a direct of being maltreated (Walsh et al., 2002). with psychosis may call into question the link between the adverse exposure and Indeed, Wigman et al. (2012) found that accuracy of the associations found. outcome. Certainly, longitudinal cohort individuals in the general population who Remembering events, often from very early studies have demonstrated that children had a parent with psychosis were more childhood, is problematic in itself, but is as young as 12 can report psychotic likely to have a history of childhood further confounded by the nature of symptoms, and these are more common trauma (including maltreatment) and psychosis, which, by definition, involves amongst those who have experienced report psychotic experiences themselves. imagining things and losing touch with

al. (2010). Schizophrenia and other psychotic disorders in a cohort of sexually abused children. Archives of General Psychiatry, 67, 1114–1119.

De Bellis, M.D., Chrousos, G.P., Dorn, L.D. et al. (1994). Hypothalamicpituitary-adrenal axis dysregulation in sexually abused girls. Journal of Clinical Endocrinology and Metabolism, 78, 249–255.

Di Forti, M., Morgan, C., Dazzan, P. et al.

(2009). High-potency cannabis and the risk of psychosis. British Journal of Psychiatry, 195, 488–491.

Dodge, K.A., Bates, J.E. & Pettit, G.S. (1990). Mechanisms in the cycle of violence. Science, 250(4988), 1678–1683.

Dominguez, M.D., Wichers, M., Lieb, R. et al. (2011). Evidence that onset of clinical psychosis is an outcome of progressively more persistent subclinical psychotic experiences: An

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8-year cohort study. Schizophrenia Bulletin, 37, 84–93.

Fisher, H.L., Caspi, A., Poulton, R. et al.

(2013). Specificity of childhood psychotic symptoms for predicting schizophrenia by 38 years of age.

Psychological Medicine, 43, 2077–2086.

Fisher, H.L., Craig, T.K., Fearon, P. et al.

(2011). Reliability and comparability of psychosis patients’ retrospective

reports of childhood abuse.

Schizophrenia Bulletin, 37, 546–553.

Fisher, H.L., Jones, P.B., Fearon, P. et al.

(2010). The varying impact of type, timing and frequency of exposure to childhood adversity on its association with adult psychotic disorder.

Psychological Medicine, 40, 1967–1978.

Fisher, H.L., Schreier, A., Zammit, S. et al. (2013). Pathways between childhood victimization and

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maltreatment and other forms of victimisation in the preceding months or years (Arseneault et al., 2011; Fisher, Schreier et al., 2013). If these early symptoms persist for several years, then the likelihood of a psychotic disorder developing is greatly increased (Dominguez et al., 2011).

However, for most children, early psychotic symptoms appear to be transitory (Cougnard et al., 2007), and it is debatable as to whether they index risk only for psychotic disorders (Fisher, Caspi et al., 2013), suggesting that they may not be a good proxy for adult psychosis.

Therefore, more evidence is required to elucidate a direct effect of childhood maltreatment on psychosis.

and affective mechanisms (e.g.

Fisher, Schreier et al., 2013).

Additionally, abused children may adapt to such a threatening environment by developing hostile attributions of others’ intentions or being hypervigilant for potentially threatening behaviour (Dodge et al., 1990). Although adaptive in the short term, prolonged difficulties in trusting close others and forming secure attachments are often considered to be a major risk factor for psychopathology.

Indeed, insecure attachment styles are prevalent amongst individuals who have experienced childhood abuse (Alexander et al., 1998) and patients with psychotic disorders, especially those with a history of abuse (Tait et al., 2004). These continued difficulties may mean that abused individuals become overly suspicious of others’ intentions and behaviour, leaving them predisposed to psychotic symptoms such as Indirect pathways Social isolation resulting from a lack of close relationships paranoid delusional beliefs and For the majority of may also reduce the likelihood that individuals are exposed to ideas of reference. Indeed Gracie individuals maltreatment alternative and normalising explanations for anomalous psychotic et al. (2007) demonstrated that occurs many years before experiences negative perceptions of others the appearance of partially mediated associations psychosis, indicating that between lifetime trauma and something must be happening in subclinical psychotic symptoms. Moreover, childhood adversity on this disorder this intervening period to lead to social isolation resulting from a lack of (Korkeila et al., 2010). the emergence of this disorder. One close relationships may also reduce the possibility is that as maltreatment in likelihood that individuals are exposed to Psychological mechanisms childhood increases the likelihood of alternative and normalising explanations Garety et al. (2007) proposed a range of being victimised in adulthood (Korkeila for anomalous psychotic experiences, and psychological mechanisms, including the et al., 2010), and this in turn is associated subsequently full-blown hallucinations development of depression and anxiety with psychosis (Beards et al., 2013), then may develop (White et al., 2000). following exposure to childhood trauma, this re-victimisation might mediate the that have also been found to increase the association between childhood Biological mechanisms risk of later psychosis. Indeed, several maltreatment and psychosis. Exploration One potential indirect biological pathway general population studies have of this possibility is required in relation to from child abuse to psychosis is through demonstrated that maltreatment is psychosis, though reports on depression such early stress having a detrimental indirectly associated with psychotic suggest that stressful events in adulthood impact on brain development. Maltreated symptoms via several of these cognitive only partially account for the impact of

psychosis-like symptoms in the ALSPAC birth cohort. Schizophrenia Bulletin, 39, 1045–1055.

Garety, P.A., Bebbington, P., Fowler, D. et al. (2007). Implications for neurobiological research of cognitive models of psychosis. Psychological Medicine, 37, 1377–1391.

Gracie, A., Freeman, D., Green, S. et al.

(2007). The association between traumatic experience, paranoia and

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hallucinations. Acta Psychiatrica Scandinavica, 116, 280–289.

Kim, E. (2008). Does traumatic brain injury predispose individuals to develop schizophrenia? Current Opinion in Psychiatry, 21, 286–289.

Korkeila, J., Vahtera, J., Nabi, H. et al.

(2010). Childhood adversities, adulthood life events and depression.

Journal of Affective Disorders, 127, 130–138.

Lo, C.C. & Cheng, T.C. (2007). The impact of childhood maltreatment on young adults’ substance abuse. American Journal of Drug & Alcohol Abuse, 33, 139–146.

Matheson, S.L., Shepherd, A.M., Pinchbeck, R.M. et al. (2013).

Childhood adversity in schizophrenia.

Psychological Medicine, 43, 225–238.

McCrory, E., De Brito, S.A. & Viding, E. (2010). The neurobiology and

genetics of maltreatment and adversity. Journal of Child Psychology & Psychiatry, 51, 1079–1095.

McGowan, P.O., Sasaki, A., D'Alessio, A.C. et al. (2009). Epigenetic regulation of the glucocorticoid receptor in human brain associates with childhood abuse. Nature Neuroscience, 12, 342–348.

Pidsley, R. & Mill, J. (2011). Epigenetic studies of psychosis. Biological

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individuals have been shown to have stunted development of several brain regions, but the findings are inconsistent (McCrory et al., 2010). Nevertheless, abnormalities in the same regions have also been found in patients with psychosis (Shenton et al., 2001), tentatively indicating a potential mechanistic pathway.

Moreover, De Bellis et al. (1994) postulated that repeated exposure to childhood abuse may also cause neurochemical changes in the brain. They found that the hypothalamic-pituitaryadrenal (HPA) axis, which plays a central role in hormonal responses to stress, was dysregulated in girls exposed to sexual abuse, and similar abnormalities have been reported in individuals experiencing psychosis (Borges et al., 2013).

Consequently, children exposed to maltreatment may have an exaggerated stress response to subsequent traumatic events, which becomes progressively amplified through repeated adverse exposures and eventually might result in psychotic symptoms.

Through interaction with genetic factors, maltreatment could also be indirectly linked with the development of psychosis in adulthood. Pre-existing genetic propensities (family history of disorder or specific genetic variants) could make individuals exposed to childhood maltreatment more likely to develop psychosis than those without such a genetic vulnerability. For instance, Collip et al. (2013) reported that individuals in their sample were more likely to have psychotic symptoms if they had been exposed to childhood maltreatment and were a carrier of the A allele of the FKBP5 gene, than maltreated individuals without this genetic vulnerability. However, a more broadly defined gene–trauma interaction for psychosis was not found by Wigman et al. (2012), indicating that further research on this potential mechanism is required.

Conversely, environmental factors have also been postulated to influence how genes are expressed and the subsequent development of psychiatric disorders. For

Psychiatry, 69, 146–156.

Radford, L., Corral, S., Bradley, C. & Fisher, H.L. (2013). The prevalence and impact of child maltreatment and other types of victimization in the UK. Child Abuse & Neglect. doi:10.1016/j.chiabu.2013.02.004 Shenton, M.E., Dickey, C.C., Frumin, M. & McCarley, R.W. (2001). A review of MRI findings in schizophrenia.

Schizophrenia Research, 49, 1–52.

instance, child maltreatment has been linked to epigenetic modifications to gene activity (McGowan et al., 2009), and such alterations in genetic expression may impact on dopamine regulation and in turn lead to the individual experiencing psychotic symptoms. Indeed, evidence is emerging that epigenetic changes precede the development of psychosis (Pidsley & Mill, 2011), though research is still required to link maltreatment and psychosis via epigenetic mechanisms in the same sample.

Behavioural mechanisms Substance misuse is another possible factor that may indirectly connect child maltreatment with adult psychosis.

Persistent and dangerous use of drugs has been demonstrated to occur more commonly in those who have a history of maltreatment (Lo & Cheng, 2007) and is considered a major risk factor for psychosis, particularly chronic use of high-potency cannabis (Di Forti et al., 2009). It seems plausible, therefore, that the higher rates of substance misuse amongst adult survivors of childhood abuse could in turn lead to the development of psychosis. Indeed, Whitfield et al. (2005) demonstrated in a general population sample that substance abuse partially mediated the association between child abuse and hallucinations.

Conclusion Childhood maltreatment is one of many risk factors for psychosis. However, this should be qualified by stating that most individuals with psychosis have not been maltreated and most maltreated children do not develop psychosis. This is important to emphasis to avoid a return to the unhelpful period in the 1950s and 1960s in the UK and US when theories seemed to blame mothers for every case of schizophrenia that emerged. Mothers and other family members are usually crucial partners in the treatment of young people with psychosis, and it is extremely

Tait, L., Birchwood, M. & Trower, P. (2004). Adapting to the challenge of psychosis. British Journal of Psychiatry, 185, 410−415. van Os, J., Linscott, R.J., Myin-Germeys, I. et al. (2009). A systematic review and meta-analysis of the psychosis continuum. Psychological Medicine, 39, 179–195.

Varese, F., Smeets, F., Drukker, M. et al.

(2012). Childhood adversities

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detrimental to alienate them from the therapeutic process.

A range of mechanisms are likely to be involved in the maltreatment–psychosis association. These mechanisms are not mutually exclusive and may simply represent different levels of the same phenomena, be sequentially involved in a causal chain or interact with each other to increase vulnerability. Identification of the various pathways that lead from childhood maltreatment to the experience of psychosis would open up opportunities for clinicians to intervene in adolescence and hopefully divert young people from following this devastating trajectory. This would have enormous benefits for the individuals and their families as well as reducing the burden on already stretched healthcare systems.

However, progressing this area of research is challenging. It will require collaborations across multiple disciplines, given that a range of mechanisms situated at different levels of analysis seem likely to be involved. In order to get a handle on the temporality of the effects, longitudinal assessments starting in early childhood and repeated through adolescence and into adulthood will be necessary, ideally on representative population-based samples.

However, as the prevalence of psychotic disorders is very low, tens if not hundreds of thousands of individuals will need to be studied to ensure sufficient statistical power to robustly detect the mechanistic pathways. Psychologists and other researchers should not be disheartened by this challenge and instead take inspiration from geneticists who have successfully formed huge international consortia to tackle questions about the molecular basis of disease.

increase the risk of psychosis.

Schizophrenia Bulletin, 38, 661–671.

Walsh, C., MacMillan, H. & Jamieson, E. (2002). The relationship between parental psychiatric disorder and child physical and sexual abuse.

Child Abuse & Neglect, 26, 11–22.

White, R., Bebbington, P., Pearson, J. et al. (2000). The social context of insight in schizophrenia. Social Psychiatry & Psychiatric Epidemiology,

Helen L. Fisher is a Lecturer and MRC Population Health Scientist at the Institute of Psychiatry, King’s College London helen.2.fisher@kcl.ac.uk

35, 500–507.

Whitfield, C., Dube, S., Felitti, V. & Anda, R. (2005). Adverse childhood experiences and hallucinations. Child Abuse & Neglect, 29, 797–810.

Wigman, J.T., van Winkel, R., Ormel, J. et al. (2012). Early trauma and familial risk in the development of the extended psychosis phenotype in adolescence. Acta Psychiatrica Scandinavica, 126, 266–273.

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Our reviewers tell us that their involvement in accreditation through partnership gives them valuable insight into different approaches to training the psychologists of the future, and offers them the opportunity to network with and learn alongside a diverse range of professional colleagues.

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Our reviewers work as part of a committee with responsibility for accrediting programmes and enhancing quality. We ask our reviewers to engage in both paper-based reviews of psychology programmes and in one or two-day partnership visits to universities across the UK. The nature and number of reviews and visits will vary year on year, but we will work closely with you to ensure that you are able to balance any work you undertake on our behalf with your other commitments.

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Out in the tropics Ian Florance talks to Peter Mitchell about teaching psychology in Malaysia

eter Mitchell has been working on the University of Nottingham’s Malaysia campus since 2009.

I talked with Peter via Skype to see what it’s like to move from the UK to teach psychology in the tropics.

‘I was head of psychology at the University of Nottingham, UK from 2005 to 2009. Nottingham has two international campuses – China and Malaysia. Malaysia offered quite a comprehensive set of courses, and we began to plan to introduce psychology into the mix, so I started to search for someone to lead the Malaysian course.

A number of things came together to make it seem attractive to do it myself! My tenure as head of school in Nottingham

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www.psychapp.co.uk is now open to all.

Advertisers can now reach beyond the prime audience of Society members that they reach in print, to include the many other suitably qualified individuals online.

Society members have the added benefit of being able to sign up for suitable e-mail and RSS alerts, and we are looking to add more

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ended, and it’s fairly common for the departing person to get out of the way to allow the new head of school some space.

And the idea of living in and discovering a new culture is, in itself, exciting. I found myself on a three-year tenure in Malaysia, which was extended to five… hence, I’ve got one year left. In 2010 I became Dean of Science on the Malaysian campus, did both jobs till October 2012 and now I’m just Dean of Science.’

I asked Peter about the challenges he encountered in developing the course.

‘We started with next to nothing in 2009, so these years have been about proactive building. We’re 10 staff and we’ll have an intake of more than 50 students this year, compared with 16 in 2009. But the biggest, most interesting challenge has been the way the profession is viewed in Malaysia and how this affects student recruitment.

‘Psychology has become a popular subject to study in the developed world.

In the UK parents tend to ask their children “What do you want to study?” and allow them a fair amount of freedom.

In the developing world, by contrast, parents have much more influence over their children’s’ choices and they want them to do something vocational, subjects like pharmacy, business or engineering. Parents want children to qualify and to be in a position to practise what they’ve learnt, and of course that’s not necessarily the case with psychology.

‘There’s another interesting difference in attitude between, say, the UK and Malaysia. My degree was a BA but over

the past few decades in the UK psychology has gone through a fascinating transition. Most degrees are now BScs, and the huge developments in cognitive neuroscience, partly driven by the development of sophisticated imaging techniques, means that psychology is seen as more a science than an art. In Malaysia, and many developing countries, this transition hasn’t always happened.

Psychology is still seen as being linked more firmly to counselling. So, when you start talking to prospective students and their parents about statistical aspects of psychology and experimental approaches they often don’t know what you’re talking about.’

Peter draws a number of implications from this. ‘Whereas in Nottingham we were very much a selection university – selecting the right candidates from the much larger number that applied for a course – in Malaysia we have to go out and recruit. This means going to careers fairs, holding open days; being in general more proactive and aiming our messages as much at parents as at prospective students. We have to stress how a psychology degree fits into job prospects through bestowing transferable skills.’

This leads to another issue for any psychological professional. ‘Given all these differences, how far should we adapt our programme to local views?

How far should the individual psychologist adapt his or her views and practice to local expectations?

Nottingham has a particular interest and concern with imaging and the scientific approach to psychology. Other courses in Malaysia don’t take as scientific a view.

We stuck to our guns and more than 50 per cent of our students will follow the psychology and cognitive neuroscience course. Our mission is quite specifically to provide a British education, so we are challenged slightly less than, say, practitioners, who probably do have to adapt more to be accepted.’

Peter is at pains to point out that he is not criticising Malaysian practice for being out of date. ‘Malaysia doesn’t have

member-only benefits as the site develops over the coming years. Please let the Managing Editor know what features you would appreciate, on jon.sutton@bps.org.uk.

Please help us to spread the word. Recruiters can post online from just £750, and at no extra cost when placing an ad in print.

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a chartership or similar structure, there aren’t published codes of practice and there aren’t, for instance, nationally recognised educational psychologists. But it is developing structures, and key people in PSIMA – the Malaysian Psychological Society – see the British Psychological Society as a model for their development.

And I can see why. Perhaps it takes living abroad to realise what a great infrastructure UK psychology has. The Society is an internationally respected organisation.’

Peter also points out that ‘it’s difficult to recruit people with the right sort of training and experience, so we recruit staff internationally from the UK, USA, New Zealand and Japan. We have to work hard to get them to relocate.’

I asked Peter how much of an upheaval it was to move to Malaysia.

‘My wife is Japanese and it’s easier to visit Japan from Malaysia, so it suited us from that point of view. And there are huge positives about living here. It’s always summer. It has a great cultural history and people are very happy and welcoming. Its cheap to live here – you don’t have to pay much to get a superb meal. Malaysia has a rich mix of cuisines.

I love music and the Malaysian Philharmonic Orchestra is world class.

The quality of health care is spectacularly good, as I know from personal experience. In 2010 we had a baby boy who suffered some neonatal problems.

He was wonderfully well looked after and is just going into pre-school. So I love it here, and I can see why many people who move here on a short-term contract end up staying here for ever. But it’s made me appreciate the UK more. I miss the seasons. I love the UK’s organisational structures, its health care, support services, even its local government.

I think British people are naturally helpful (with one or two geographical exceptions!). I’m looking forward to going back to see Nottingham Forest, though top clubs like Arsenal, Liverpool, Chelsea, Manchester United and City have come over to play exhibition games against the national team outside the UK season.’

I asked Peter if he had any other comments. He thought a while, then said ‘I suppose that because the Malaysian campus is smaller than the UK one there’s more communication between different departments and disciplines, allowing wonderful opportunities to connect with, and learn from colleagues in disciplines other than psychology. This particularly helped me as Dean of Science and I think it will affect what I do when I come back to the UK.’

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Ups and downs in occupational psychology Lucy Standing on the working options of occupational psychologists, and on her role as a social entrepreneur or the purpose of this piece, I’m assuming you have a fairly good idea of what an occupational psychologist (OP) does. I currently work freelance but I’ve also worked in consultancy and in-house. As these are the three main ways in which occupational psychologists work, I’ll use this article to describe the main benefits and downsides associated with each.

I also work as a social entrepreneur, which I’ll briefly explain towards the end of this article because it’s relevant to our field.

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administrative time to do these things.

Even if you choose to hire an accountant or other experts, you’ll need to still spend this time researching your options.

I do largely the same sort of work I did when I worked full time. I run lots of training courses, development interventions and I do a lot of assessment work. The longer you do it, the more you build up your own name and brand.

Freelancing/associate work I’ve noticed more and more people working freelance: the unrivalled flexibility and tax advantages are no doubt significant, but as occupational psychologists, we can’t overlook theories of motivation – I believe the increase in freelance workers is down to the fact that it allows you more chance to pursue work you find more meaningful – Maslow’s stage of self-actualisation.

As the money side of things is always the burning question most people considering a freelance career want to know, I’ll get it out of the way. I charge £1000 a day.

This varies – I’ll do interesting work on a pro-bono basis too.

When I do associate work (which is when I work for another firm under their Lucy Standing is a Chartered Psychologist and works on name), I usually get between a freelance associate basis as well as running her own £600 and £950. The last time consultancy business and not-for-profit website neuTrain I worked full time (eight years lucy@neutrain.net ago) my salary was £50,000 @neutrain p.a. In my first freelance year, I earned £54,000, but paid less tax and worked around 80 days as opposed to the 200 days plus a year I had been working The main benefits I Flexibility – I get to take as much previously. holiday as I like. My main reason Running your own freelance business for freelancing was because I started requires that you run a company – it a family. I have three children, who might be small, but you still need to will only be young once. I want to be complete annual tax returns and company around as much as possible and never returns. You’ll need plenty of

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worry about my promotion prospects suffering.

Autonomy – I never work until 10 or 11pm unless I want to. If I want to take a taxi home, I don’t have a company policy saying it’s unacceptable. I make my own decisions.

Portfolio career – I have a fairly entrepreneurial streak. I used to also run a hotel, which I enjoyed turning around to become a successful business. Working freelance allows you to indulge other passions, which can enrich what you can bring to the table as a psychologist.

Research – I do more research now than ever before. I read more books and articles and engage much more in the ‘psychology’ of what we do.

I would like to thank the BPS for their provision of PsychSource and the Occupational Digest – I use them a lot.

Main downsides I Isolation – I miss the banter of the office and the muffin mornings. I miss working with other bright, intelligent people I respect. I still meet people but it’s not the same as working with them daily.

I Unpredictability – Money isn’t guaranteed. The best freelancers will be busy during the slowest and quietest recession. It’s all down to relationships.

If you have good clients, the transition is easier. If you have no clients, you’ll need to go through the associate route where you’ll not know much about the pipeline of work coming in. For some this is unsettling.

I Extra tasks – Working for a larger organisation brings the benefits that other people worry about your IT network and company tax returns.

Work on your own and this all falls in your lap.

Consultancy I’ve worked for two consultancies – both of whom had different styles, but the need for business development was common to both. I personally find this empowering, but some find this threatening: failing to bring in any business month after month can make people feel very exposed.

The main part of the job is around

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working with clients to understand 3 or 4am simply because a project an issue, propose and develop an might not have been scoped properly. intervention and hopefully, to evaluate Fine if it’s your project, but when it’s what impact you’ve had. When I worked someone else’s you can feel shortfull time, a typical week would look like changed. this: Sunday: Depart late afternoon to Working in-house Durham to deliver a coaching workshop My first role in OP was working for on Monday morning. Travel home and a US investment bank. I designed arrive back at 10pm. Tuesday: Meeting in graduate recruitment processes and London with a client. You are developing eventually moved into managing the an assessment centre for their graduate function and then moved to head up interns and you are meeting to discuss recruitment globally at a strategy issues and update them on progress. consulting firm. Your ‘clients’ tend Tuesday afternoon is spent following to be the managers who work for the up the meeting and responding to other organisation and your colleagues in e-mails. Wednesday: You’ve been booked HR who come to you as a specialist. in to run some focus groups in Leicester.

A typical day would look something You get up at 6am to be there for a 10am like this: Get to your desk and catch up start. You spend the afternoon writing up on a few e-mails. Briefly catch up with a the results. Thursday: You get to work colleague who has prepared an interview from home: you have some reports from schedule for a round a development centre to of hires they are assess. Friday: You go into doing and they want the office and catch up on “how lucky we are to have your input to give admin, meet up with your it the ‘thumbs up’. team members, get briefed this qualification in our Get back to three on an assessment and bags” voicemails – mainly workshop you’ve been from external vendors booked in to run next wanting to get on to week. a preferred supplier list or wanting you to advertise in their HR magazine. Grab Main benefits I Variety – I never knew weeks could fly a sandwich and eat it at your desk. Meet like this until I worked in consulting. an external vendor – you’ve commissioned It was engaging and enjoyable, and if a new training programme on presentation you didn’t like something you weren’t skills and need to check progress. You doing it for long. need to follow up by sending over some I Interest – Different clients, different files and templates. The diversity manager projects, different experiences. You asks you to meet next week to discuss can’t fail to find something of interest. how to address institutional racism; you I The people – You work with likeagree a time to meet. You’ve been asked to minded people doing similar roles run an interview next week for a new HR who share an interest in the field. It’s hire. You spend 15 minutes trying to brilliant to have the free resources of find a suitable room you can book! your colleagues’ brains with whom to The e-mails have kept arriving so you push ideas around. go through a few of those before you get down to trying to finish off the new Main downsides appraisal form you are designing.

I Business development– I love doing You do this five times over to get business development and can network a typical week. well. But if you don’t bring in work, Main benefits expect to be in the firing line.

I Politics – You get politics everywhere I The long-term impact – I loved working you go, so let me clarify. Who gets the where I could see the impact of my credit for a sale, when one person was work year on year. I could see the called by a client, but someone else did graduates I hired turning into great the proposal and then someone more traders or consultants, I could see my senior accompanies you to a company climbing the top 100 graduate presentation? You’ll sometimes find employers, I could assess the validity of you’ve done most of the work and yet my assessment centres. Because I could everyone wants credit. It’s not see the results I knew I was having surprising that on occasion this can a positive and meaningful impact.

I The money and power – This really leave bad feeling.

I The hours – I’ve sacrificed evenings and applies only to working in investment weekends travelling or working until banking or strategy consulting. Both

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pay well. I literally took a 50 per cent pay cut to move into consultancy. I also had a very decent budget with which to hire and manage external vendors. If you are in this position it is a privilege.

Being a specialist – As one of the only ‘psychologists’ in the bank I would be asked to consult with others and feed into their meetings. I enjoyed having that identity.

Main downsides I Being a ‘cost centre’ – Because you are a ‘cost centre’ you need to justify your existence on an almost daily basis.

I Isolation – Working as an OP within a larger HR department, you can feel isolated. Because others don’t know your role, you have to manage their expectations more constructively.

I Politics – Because of the ‘cost centre’ point above and people needing to justify their existence, HR business partners don’t always like it if people in ‘the line’ come to you directly; it cuts them out of the equation. They prefer it if you provide them with a service they can then provide to their line managers. The ability to tread carefully and not upset anyone is important.

I The hours – I used to get to work for 7.30am latest and if I got home before 9.00pm it was a bonus. I also had to give up the odd weekend.

Finally, I’ll say something about being a social entrepreneur – I say social because I refer to myself as ‘volunteer’.

I do what I do through choice. My goal is to make the training world more efficient and to help OPs who get involved in training work. We share our training materials free online. I don’t ask people to register (I’m not list-building). There are no adverts on the site – it’s purely about helping the OP and the wider training & L&D community to get smarter about sharing and building on each other’s knowledge. This isn’t pure OP, so I won’t elaborate here, but if you’d like to learn more, look at the website (www.neutrain.net), where plenty of other brilliant occupational psychologists have published their content so you don’t need to waste time reinventing it all.

Overall, the main thing I’d say about occupational psychology is how lucky we are to have this qualification in our bags.

It enables you to work in almost any way you’d like and you can apply it to anything, provided you step outside our fairly insular (sorry) world. Information is now free – so it has very little value.

The value we provide is how we apply what we know and make it interesting and relevant to others.

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‘An emotional but ill-ruled machine’ Sarah Chaney looks at how late 19th-century psychiatry interpreted and explained self-mutilation

ost of us are probably familiar with the modern usage of ‘selfharm’ to describe self-inflicted tissue damage. But where did the idea come from? Today, self-harm generally refers to superficial injury to surface tissue, in particular by cutting. However, a historical perspective shows that this is a relatively recent way of defining selfinflicted injury. In other eras, different sets of acts and ways of understanding them have been a focus for concern.

My recent PhD research explores the creation of a category of selfmutilation in late 19th-century asylum psychiatry. While people had certainly intentionally injured themselves before this time, the late 19th century was the first occasion that diverse acts – from amputation to hair-plucking – became regarded as equivalent under a common term: ‘self-mutilation’. It was also in this period that psychiatrists began to interpret intentional acts of tissue-damage as psychologically and culturally meaningful.

In the second half of the 19th century, the term ‘self-mutilation’ began to appear in asylum literature. Beginning in the 1860s with a few articles by alienists (as asylum psychiatrists were known), the literature was expanded by case studies in the 1870s and 1880s. The category was fully endorsed by a five-page definition in Tuke’s Dictionary of Psychological Medicine in 1892 (a multi-authored two-volume textbook that aimed to include all contemporary theories and diagnoses).

For 19th-century alienists, self-

references

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Anon. (1882) The case of Isaac Brooks.

Journal of Mental Science, 28, 69–74.

Editorial: ‘The case of the farmer Brooks’.

(1882), The Lancet, 119, 3046, 73.

Engelstein, L. (1997) From heresy to harm: Self-castrators in the civic discourse of late Tsarist Russia. In T. Hara & K. Matsuzato (Eds.) Empire and society: New approaches to Russian history.(pp.1–22). Sapporo: Slavic Research Centre.

mutilation referred to a broad set of practices. As Peter Maury Deas, Medical Superintendent of Exeter’s Wonford House, put it in 1896: I have had many cases of selfmutilation not distinctly suicidal, such as exhibit habits of flesh-picking, biting the fingers, or biting other parts of the body, pulling out hair, or eating rubbish. (Maury Deas, 1896, p.104)

More extreme acts of injury, including castration, amputation and eyeenucleation were also referred to as non-suicidal by most physicians, and published reports frequently concentrated on these dramatic examples.

This practice of viewing acts that could, on the surface, seem very different as one broad category led to a particular way of characterising and understanding self-injury. Alienists were influenced by the popularity of theories of evolution.

Just as evolutionary development was thought to progress along a gradual scale (from primitivism to civilisation), psychiatrists identified a similar gradation of self-mutilation. Thus they compared major injuries in those certified insane with the ‘nervous, fidgety, restless habits…common among nervous people who are not insane’. Indeed, alienists regarded the extent of these nervous habits (including nail-biting, skin-picking and fidgeting) as a ‘valuable criterion’ of a patient’s mental condition: an indication that the nervous patient might be at risk of developing outright insanity.

Maury Deas, P. (1896) 'The uses and limitations of mechanical restraint as a means of treatment of the insane', Journal of Mental Science, 42: 102–113.

Gould, G.M. & Pyle, W.P. (1897) Anomalies and curiosities of medicine. London/ Philadelphia: Rebman Publishing Co./ W.B. Saunders.

Savage, G.H. (1883) ‘Marriage in neurotic subjects’, Journal of Mental Science, 29, 49–54.

An example from my research is 30-year-old Edith Mary Ellen Blyth.

On admission to Bethlem Royal Hospital in 1893, doctors noted that she had been ‘subject to hysterical symptoms for eleven years but [was] never of unsound mind’, and that the patient had never previously been confined. Over the last five years, Blyth had been seen by a variety of doctors for a presumed skin complaint, until ‘last June [she] was taken to Mr Treves [elite surgeon Frederick Treves] who said the sores were self-inflicted and they ceased to appear soon after this.’

Blyth’s admission to Bethlem was, it seems prompted by her resumption of self-injury, now interpreted as a nervous symptom.

Those familiar with asylum history might have expected that writing on selfmutilation emerged from the bureaucratic nature of the expanding late 19th-century asylum system, as well as psychiatric concern with the expansion of diagnostic nosologies. However, this was not the case. In fact, most of the alienists writing on the topic did not embrace ‘medical materialism’ (a somatic approach to insanity) and hereditary models of illness wholeheartedly. Instead, they drew on a variety of fields – including anthropology, normal psychology, spiritualism, theology and literature – in their efforts to explain self-injurious acts. The diversity of their approaches, as well as the belief that selfmutilation could be compared in sane and insane persons, led alienists to claim that self-injury described more than just a physical wound. Instead, they considered that it could be analysed to uncover underlying mental or emotional meaning.

This is particularly evident in a case reported in an editorial in The Lancet in 1882 as, without doubt, ‘one of selfmutilation from insanity’. This was the attempted self-castration of a young farmer from Leek in Staffordshire, Isaac Brooks. In 1879 Brooks had called his doctor to treat a cut-wound to his scrotum. When asked about the injury, the farmer claimed he had been attacked by three men, two of whom were later sentenced to 10 years imprisonment for the crime.

Brooks was treated for a similar injury a year later, giving the same story, but this time refusing to name his attackers.

However, the case did not receive public attention until the farmer died, of an unrelated illness, in December 1881. On his death bed, Brooks signed a confession stating that the men were innocent and, according to reports, that the injuries were self-inflicted. There was huge press interest in the case, locally and nationally, as well as coverage in medical journals.

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Perhaps surprisingly, few reports focused on the miscarriage of justice.

Instead, attention centred on the character, personality and life of Isaac Brooks himself, and how these might explain his curious acts. Most writers agreed that Brooks must have injured himself, and many felt this proved he had been insane, although he had never been thought so in life. Other motives were put forward, ranging from financial interests to guilt over past sexual misdemeanours; one newspaper even went so far as to claim (with very little evidence) that the farmer was a ‘rustic Don Juan’!

Castration – attempted and successful – was a major focus in published material on self-mutilation. The Brooks case, The

BETHLEM ART & HISTORIES COLLECTIONS TRUST

to create a focus on self-castration as the major form of self-mutilation within asylum psychiatry. Twenty years later, reflecting back on published reports, two American physicians claimed: ‘Selfmutilation in man is almost invariably the result of meditation over the generative function, and the great majority of cases of this nature are avulsions or amputations of some parts of the genitalia’ (Gould and Pyle, 1897, p.732). If this emphasis was not, in reality, the case, why was this topic so important to contemporaries?

It is easy to assume that concern around castration arose from what historians have described as a ‘crisis’ of masculinity in this period. An increase in sedentary occupations among the middle classes and changing attitudes to family life significantly altered the male role in the late 19th century. Reports on selfcastration by alienists were certainly connected with ongoing concern around other aspects of male behaviour considered troubling: the ill-effects of masturbation and ‘antipathic sexuality’ (homosexuality).

In both these instances, however, doctors made an important shift in this period from biological to psychological explanations. They increasingly described masturbation as mentally, rather than physically, damaging to the individual. Early sexologists, such as Richard von Krafft-Ebing in Vienna, also claimed that homosexuality was a psychological state and not, as had In the late 19th century diverse acts – from previously been suggested, related to amputation to hair-plucking – became regarded under-developed sex organs. as equivalent under the term ‘self-mutilation’ Alienists were also increasingly claiming sexual development to be an important psychological period in Lancet claimed, was ‘no isolated one. the life of an individual, particularly men.

There are many well-authenticated cases I shall illustrate this with two examples: of youths and men of all ages who have first the afore-mentioned Brooks case. sometimes successfully…performed this In the Journal of Mental Science (the painful operation upon themselves.’ Yet main periodical for asylum psychiatry), my research into asylum records indicated a lengthy description of Brooks declared: that self-castration was relatively ‘The man was single, and lived a very uncommon. At the Bethlem Royal subjective life; he was just the type of Hospital, just four patients attempted man in whom all the evils of civilization castration in 20 years, such as 19-year-old seem to accumulate, great sensibility, with clerk Alexander Thomson, who was loss of power of control, an emotional but admitted in 1888 after he ‘cut his private ill-ruled machine. A solitary man, parts with a razor’. In contrast, far more thinking himself misunderstood and than four patients each year picked their neglected, building castles in the air, faces, pulled out their hair or knocked finding the times out of joint, and from themselves against the wall or floor, and this idea conceiving that he has enemies an average of one a year attempted to and persecutors’ (Anon., 1882, p.73). pluck out their eyes.

Given that the author of the above The case of Isaac Brooks thus helped had presumably never met Brooks (who

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was already dead), these words make more sense when compared with my second example: the Russian Skoptzy.

This religious sect, who practised ritual castration, came to the attention of British psychiatrists in the same period, through criminal trials such as that over the property of the wealthy Plotitzine in 1882. Although the castration was not literally self-performed, British writers invariably classed it as such: one newspaper even compared the Isaac Brooks case to the practices of the sect.

Members of the Skoptzy were regularly tried and exiled to Siberia by the Russian authorities for their heretical beliefs. In the second half of the 19th century, however, the case against them became increasingly secular. For contemporary writers, sexual behaviour was what defined the normal man: governing his rights and responsibilities, and encouraging rational self-control.

As George Savage, a well-known British alienist and superintendent at Bethlem Royal Hospital, put it in 1883: ‘the sexual function is the function which develops altruism, so without children the parents become egotistical, and egotism and insanity are not far apart’ (Savage, 1883, p.53). Savage and his colleagues linked the growth of ‘sexual feelings’ in puberty with the development of ‘the highest feelings of mankind’. Conversely, as Russian writer Evgeny Pelikan claimed of the Skoptzy, castration removed the individual’s ability to relate to his fellows.

‘The young man castrated before puberty ... remains indifferent to his environment, lacking the smallest germ of noble aspiration, sense of duty, or civic obligation’ (Engelstein, 1997, p.12).

Late 19th-century doctors thus characterised both Isaac Brooks and the Skoptzy as selfish, with their acts of selfcastration viewed as direct evidence of this state of mind. This model of selfmutilation is very different from the modern idea of self-harm. An emphasis on self-castration in this period (well out of proportion to the number of cases) is explained by the increasing psychological emphasis on the sexual instinct in individual development. The growth of sexual desire was heavily associated with the acquisition of self-control and altruistic feeling: conversely, selfcastration was read as impulsive and egotistical, whether it was thought to be a symptom of insanity or not.

I Sarah Chaney is a Research Associate of the UCL Centre for the History of Psychological Disciplines s.chaney@ucl.ac.uk

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