The Psychologist August 2017

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psychologist august 2017

The future of transport?

The psychology of self-driving cars, with Stephen Skippon and Nick Reed

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psychologist august 2017

contact The British Psychological Society 48 Princess Road East Leicester LE1 7DR 0116 254 9568 mail@bps.org.uk www.bps.org.uk

The future of transport?

The psychology of self-driving cars, with Stephen Skippon and Nick Reed

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The Psychologist is the magazine of The British Psychological Society It provides a forum for communication, discussion and controversy among all members of the Society, and aims to fulfil the main object of the Royal Charter, ‘to promote the advancement and diffusion of a knowledge of psychology pure and applied’

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psychologist august 2017

Letters Grenfell Tower

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The future of transport?

Driverless cars, with Stephen Skippon and Nick Reed

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Books Reviews, and ‘A book that shaped me’

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News Awards, research, and much more

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Forgiveness Loren Toussaint and Everett Worthington Jr

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‘I came into safety by accident’ An interview with Professor Andrew Hale

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The hidden costs of working when sick Mariella Miraglia and Gail Kinman

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Careers We meet Barry and Ann Cripps; and Hamira Riaz; plus featured job and latest vacancies

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When winners need help Derek Larkin and colleagues on mental health in elite sport

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Culture Including the winner of our annual poetry competition

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Seeing red G. Neil Martin on the evidence

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A to Z H is for…

Dr Jon Sutton Managing Editor @psychmag

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In 2012 the Institute of Civil Engineers were after a catchy hashtag to promote their work and the societal impact of their discipline. Eschewing the more obvious #CoolasICE/#ICEICEBaby options, they settled on #ThisIsCivilEngineering, and hundreds of projects and partner organisations have now joined in by raising their ‘This is Civil Engineering’ banners.

What might #ThisIsPsychology look like? Where would we hang our banners?

It’s almost easier to think where we wouldn’t hang them. If just this one issue is anything to go by, they would festoon driverless cars, the beds of patients in ‘the grey zone’, sporting stars, sniffling workers and safety manuals, anyone looking to forgive, and so much more.

As for the more ineffable side of things, we continue to probe at the boundaries of science and art with the winner of our annual poetry competition: Ilyana Kuhling with ‘Multitudes’. We contain multitudes; so does psychology.

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At the flimsy border between life and death We hear about Adrian Owen’s journeys Into the Grey Zone

Leon Neal/Getty Images

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Responding to the Grenfell Tower fire As I write this, there has been much comment on Grenfell Tower, even before the fire has been fully extinguished. Discussion points so far have ranged across the subjects. From the initial queries of the physical sciences: What was the point of ignition? How did the fire spread so quickly? Is the building stable? Through to the social science questions: How are the survivors being supported? What impact will this have on the community, and how can it recover and rebuild? Although I share these questions, I find myself asking a few others for the immediate time frame, and into the near future.

The Fire Commissioner of London has stated that the focus of her concern for her staff is not their physical wellbeing, but their emotional wellbeing following what they witnessed. I support her assessment of this situation.

This first fire engines were in attendance within six minutes of the first call to the emergency services (something we should never underestimate in terms of positively influencing outcomes). This means they will have been exposed to a range of sights, smells and sounds from the moment they stepped out of the cabs. There would have been people who needed to be directed safely away from the building and an unknown number who were staying in their flats as instructed. As time went on, the knowledge of possible numbers of people still inside the building would be filtering through. As the building became more compromised, they would have to navigate falling debris, unstable parts of the structure, shouts from people in the building above them, and from survivors behind them who were trying to locate relatives they had been separated from whilst evacuating. There would have been interactions with members of the public who started to gather at the cordons. They would have been witness to people who jumped or fell from the building. They train for this kind of incident regularly, but the scale and complexity of this fire brought with it some extra challenges, which are likely to be potential risk factors when it comes to their emotional response.

At incidents that the Fire and Rescue Service responds to where people are trapped there are two priority actions: to search the building and extricate the casualties as soon as it is safe to do so. As the fire continued to develop so they would be able to understand, well before the media, the increasingly precarious conditions for those inside. Talk to any fire fighter and they will say that their ultimate purpose is to protect life. For those 200 fire fighters that night, they could not do this freely due to the limited number of entry/ exit routes and the speed and intensity of the fire. We know that traumatic reactions are more likely to be chronic and severe when the experience is accompanied by a feeling of helplessness. Although the fire fighters at this scene would have been going in to search the building and rescue residents where and when it was safe (enough) to do so, the intensity of the fire meant that they did not (as a service) have the opportunity to do this to the full extent.

Knowing there are potentially hundreds of residents still inside the building, knowing the likely conditions inside and not being able to locate and evacuate them quickly, are thoughts that are likely to stay with these fire fighters.

Alongside this, the experience of seeing people jumping or falling from the building would be another exacerbating factor. The biggest loss to the international fire-fighting community was the 9/11 World Trade Center.

We know now that seeing people jumping to try and save their life, or end it through their choice, was particularly difficult for those fire fighters. We might expect a similar response from fire fighters attending the Grenfell Tower incident, particularly as some are also recovering from things they witnessed in recent terrorist attacks.

After the initial response, they will then move to a protracted search and recovery operation alongside the other blue light services. We have

the psychologist august 2017 letters learnt from 9/11 and natural disasters that protracted searches for body recovery come with a risk of burnout.

The repetition of searching through that environment, carefully and purposefully, risks emotional exhaustion.

Further down the timeline that will now unfold from this sad incident for years to come, there will be fire investigations, coroner’s court proceedings, parliamentary inquiries and probable court cases. This means the support offered to colleagues needs to continue for those individuals through the rehearsal and examination of their actions in these processes. There has been some work completed about the traumatic reactions which present alongside these kinds of procedural, judicial proceedings and sometimes we see an increase in distress when emergency service personnel participate in these processes.

With these risk factors in mind, I will return to my question about supporting the fire fighters who attended.

Two days after the Grenfell Tower fire, I chaired the first National Trauma Support Conference for the UK Fire and Rescue Services hosted by Tyne and Wear Fire and Rescue Service. This conference had been planned for six months: it just happened to occur at this time, it was not in response to the Grenfell Tower incident. The UK Fire and Rescue Services are all too aware of the psychological risks their profession presents to them.

The Grenfell disaster felt like an alarm going off inside of me. Maybe it was the three terror attacks having happened within a month. Maybe it was the emotional temperature stirred up by the election and Brexit and austerity. Maybe it was just the sheer horror of such a huge, brutal and preventable tragedy.

Individuals and organisations have started to develop organised responses, based partly on lessons learned from previous disasters, on the best available evidencebased practice guidelines, and on information coming in from the ground as to what might be needed for this particular situation. Local emergency and NHS services, as well as voluntary groups have attended to urgent needs and begun to structure care pathways for providing support in the longer term. Professional bodies have also started developing their own responses. The UK Psychological Trauma Society have modified their conference programme to include a workshop on ‘Psychosocial Disaster Management Response’. Changing Faces have posted a statement on their website describing their

The conference was not arranged to ask what they can do to support their colleagues, but to share existing good practice between the services. Most services have peerto-peer support of some kind which they use to help colleagues after incidents which have affected them.

Tyne and Wear are, in my opinion, one of the national leaders in their approach of providing trauma support to their fire fighters. The questions being asked at that conference were not what should they do, but how can they continue to share practice, develop and improve.

This changes our response as a profession of psychologists to an incident such as this. After other major incidents in other parts of the world we have seen psychologists offering to assist where they can. Although very noble, the knowledge that sound, evidence-based practice already exists in the UK Fire and Rescue Services steers us away from claiming that space as ours, and instead leads us to the question of seeing how our offer as psychologists can complement existing, embedded good practice within the Fire and Rescue Service community.

This is how our profession can support the fire fighters both in the immediate days after the fire, and longer term over the coming months and years.

Dr Rowena Hill Principal Lecturer Nottingham Trent University

position on the Grenfell tragedy.

Trauma Aid UK are offering free CPD to practitioners who can commit to providing pro bono EMDR therapy. Of course, there are always people who fall through the gaps – people who feel unable to access or afford care for many different reasons. Doctors of the World have started sending out mobile teams in order to care for hard-to-reach groups such as these.

Like many others, I also wanted to pour the energy I had into a helpful and coordinated response.

So after contacting the BPS, I began to collect names of people who were willing to offer their services for free – with a view to support other services that were operating at full capacity. Immediately I ran into the tensions between rushing in and standing back, between being naively reactive and being thoughtfully proactive, between feeling hopeful and hopeless. There are understandable and important concerns regarding the unintended consequences of some of our helping behaviours in these rare and horrific circumstances. The risk of re-traumatisation of the survivors, vicarious traumatisation and burnout

of unsupported aid workers, of focusing solely on trauma work when there will be many other issues arising such as bereavement, burns, injuries, appearance concerns, and of course social justice. ‘Do No Harm’ workshops and volunteer support events are being run to minimise the risk of these problems occurring, but may not be enough.

The psychological wounds arising from this event will unfold over the long term and will stretch our already reduced statutory services. I have been heartened by the positive response of many psychologists willing to help. I hope to find a way of putting this directory to good use in order to contribute to the expertise and compassion that already exists within our service structures. As psychologists, we have many skills in direct and indirect clinical care as well as academic research, from within NHS, university, third sector and independent practice settings. Suggestions are welcome!

Dr Jessica Munafò Honorary Clinical Psychologist Traumatic Stress Service, Avon and Wiltshire Mental Health Partnership NHS Trust

Back to academia… and elephants Ella Rhodes reports on a Fellowship scheme that helps academics return after a career break

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he Daphne Jackson Trust, which helps STEM academics back into research after a break of two or more years, taken for family, health or caring reasons, is urging psychologists to apply for its Fellowships. The charity offers flexible, part-time and salaried fellowships in universities and research institutes across the UK. We spoke to Dr Lucy Bates, who is researching elephant cognition, about how the Trust encouraged and supported her on the journey back into the world of academia.

Bates completed a PhD in evolutionary psychology at the University of St Andrews studying chimpanzee cognition in Uganda. She then went on to join the longestrunning study of African elephants at the Amboseli Elephant Research Project in Kenya for her postdoc research – also with St Andrews.

She said that before this postdoc little was known about the animal’s cognition, despite them being seen as ‘clever’. ‘Experiments we conducted in that postdoc showed that elephants recognise individual family members – based on their urine – and, moreover, keep track of where those individuals are in relation to themselves, for example far away and separate from the current group, or in the group and walking in front, or with the group and walking behind.’

During this work she also showed that elephants have amazingly sophisticated classification skills and

can differentiate between different human ethnic groups.

‘The elephants show an intense flight reaction specifically to the scent of Maasai men, but not to the scent of Kamba men: another tribe in Kenya that unlike the Maasai do not have a history of negative interactions with elephants in Amboseli.’

Following this work Bates’s partner was offered a job in South Africa, and she went along to write up existing data and get experience working in conservation projects in the country. She said: ‘It is impossible to do animal field work and not get drawn in to conservation – the threat that there won’t be any wild animals left to study soon is horribly real!’ She spent time working with NGOs, and rather than answering questions about elephants it only opened up more. After four and a half years in South Africa, having her first child, she said while thoughts of returning to research had gone away, the questions she was hankering to answer hadn’t.

While eight months pregnant with her second child she happened upon an advert online for a Daphne Jackson Fellowship, hosted and sponsored by the University of Sussex – one of the few psychology departments in the UK with professors studying elephant cognition. Although Bates’ Fellowship was advertised and fully sponsored in a specific STEM discipline and geographical location, the Trust also accepts applications

the psychologist august 2017 news on a rolling basis. In these instances, the Trust will secure sponsorship once a fellowship proposal has been approved and accepted by the Trust.

Twelve days after her second child was born, and six and a half years after she left her last academic position, she had a Skype interview with the Sussex Psychology Head of School, a representative from the Trust, and two other School of Psychology faculty members. She was selected to submit a full application and develop a proposal for the research and retraining she would undertake. ‘I think the level of oxytocin in my body really helped me! I’ve never felt so relaxed during an interview, even despite knowing how much was riding on it. Seven days earlier, my husband had also had a Skype interview for that impossible job, and had been offered it the day before – so moving back to the UK was suddenly really on the cards.’

Bates is now studying culture and potential social learning in elephants. ‘Elephants have very long periods of juvenile dependency, and it is frequently assumed that social learning must be a significant part of their lives, giving them lots of information that would be too difficult or costly to acquire on their own.

But there is actually very little evidence for any social learning in elephants – probably largely based on the immense difficulties of demonstrating social learning outside of a lab, and elephants not easily fitting into labs.’ She and Professor Karen Mccomb (University of Sussex) are also hoping to get funding to expand this line of research.

Bates said, with six months left of her Fellowship, that her experience of the Trust had been entirely positive and its staff were very understanding of the difficulties faced in returning to academia after a break. ‘They deal with all the aspects so well – from the practical exercise of an extensive application process that is designed to make sure we hit the ground running when we do actually start research again, having planned it all very carefully, to the emotional side of feeling guilty about returning to work, and feeling utterly unconfident and the proverbial “impostor” who is not quite up to it anymore.’

However, Bates added, the emotional support she had received from employees of the Trust and other Fellows had been the most helpful aspect.

She said many of her peers from her PhD are now associate professors, readers and professors with long publication lists and huge H-indexes. ‘They are not catching up with what is going on in the field, they are the field! Not that I would change any of the past 15 years from when I started my PhD, but just knowing there are other people who are returning and feel as daunted as you, but who are dealing with it and getting results, is really very inspiring.’

If you’ve taken a career break of two or more years for family, caring or health reasons and would like to find out more about returning to research with a Daphne Jackson Fellowship, call 01483 689 166 to speak to Trust staff or visit daphnejackson.org.

Queen’s Birthday Honours BPS members with expertise in behaviour change and learning disabilities have been named in the Queen’s Birthday Honours. Professor Theresa Marteau has been made a Dame for services to public health and Dr Melanie Bruce received the British Empire Medal for services to children and families in Norfolk.

Professor Marteau, Director of the Behaviour and Health Research Unit at the University of Cambridge, researches population and individuallevel behaviour change interventions in eating behaviours, exercise, smoking and alcohol, with a focus on non-conscious processes. Marteau, also a Fellow of the Academy of Medical Sciences and of the Academy of Social Sciences, said: ‘This is a huge honour. It is wonderful to have recognition for the contribution that behavioural science can make to improving the health of the population. I am also proud to be a role model to more junior women scientists.’

Clinical psychologist Dr Bruce works with Starfish+, a specialist service for children and young people with learning disabilities in the county. Describing receiving the news about the BEM award, she said: ‘It was a complete shock. When they phoned I said “I thought you were inviting me to jury service!”.’

Starfish+ works to avoid children being moved away from their families as a result of their behaviour and/ or mental health needs. Bruce said she was ‘very passionate about enabling children to live at home and have warm, loving and positive relationships with their families’.

She paid tribute to the whole team, modestly adding: ‘I feel a bit awkward and embarrassed about it as I know so many psychologists and other health professionals who do amazing jobs and I don’t feel as if I do anything different or more to justify such an award.’

Tracey Brown, the Director of Sense About Science, has also been awarded an OBE, for services to science. The British Psychological Society is a partner in several Sense About Science initiatives, including the Evidence Matters campaign. ER

Professor Theresa Marteau has been made a Dame

News online: Find more news at www.thepsychologist.org.uk/reports, including: Madeleine Pownall’s reports from BRAINFest in Cambridge.

For much more of the latest peer-reviewed research, digested, see www.bps.org.uk/digest Do you have a potential news story?

Email us on psychologist@bps.org.uk

Making an impact

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A psychologist whose research has helped to overhaul the way vulnerable witnesses are interviewed has received an award from the ESRC. We spoke to Professor Amina Memon (Royal Holloway, University of London) about her career path and plans to have an impact on evidencegathering and interviewing among those seeking asylum.

Memon’s award for Outstanding Impact in Public Policy marks the fifth year of the ESRC’s Celebrating Impact Prize. Memon, who also received £10,000 prize money, began her research career looking into eyewitness memory in adults, and both the increasing study of cognitive interviewing techniques and highprofile cases of alleged child abuse led her to tackling a tricky dilemma.

She explained: ‘There were conflicting views about whether children would make things up as innocent witnesses, or whether they could be competent witnesses if they couldn’t understand the difference between the truth and a lie.’ If the latter was the case, and children couldn’t be seen as competent witnesses, Memon said this raised serious questions on how best to investigate crimes where a child was the only witness.

Memon and colleagues adapted the cognitive interviewing technique, which involves a detailed narrative style of reporting, open-ended questions and instructions to reinstate context, and they tested it on sixto seven-year-olds and eight- to nine-year-olds following either an eye test scenario or a magic show. While the younger children struggled to provide much detail, the slightly older, and more verbal eight- and nine-year-olds, gave comprehensive, detailed and accurate testimonies.

The interview alone wasn’t the only important part of getting such detailed accounts, Memon said, but the process of building trust and rapport before an interview helped children remember and recount what had happened. Later work showed the cognitive interview technique can also be used for children with learning disabilities and, with some modifications, adults on the autistic spectrum.

In the late 1990s Memon was responsible for writing guidance on interviewing children for the Scottish Executive, including some further documents on how to interview traumatised children who were undergoing therapy but whose evidence needed to be collected without contamination from this therapy. She said: ‘I was able to directly translate the research findings that came from what we knew about how best to interview child witnesses and put this information in the guidance document.’

Next Memon began to look into the best ways to interview and gather evidence from older adults, as well as their facial recognition abilities. She said there were concerns, some quite stereotypical, about the reliability of older witnesses. However although her lab work showed older witnesses may have trouble picking out a person from an identity parade, her field work showed they are also very cautious when doing so. ‘Provided you question

a person appropriately and tell them the suspect may or may not be in the identity parade, older adults can follow those instructions and be cautious where they are not sure.’

Further research also showed older witnesses were not more susceptible to confusing their recollection of events with the recollection of another witness. Indeed, Memon’s research review has shown older people to benefit from cognitive interviews perhaps even more than younger people.

Memon now plans to take a year-long career break but has plans for the next group of witnesses she hopes to work with – those seeking asylum. Addressing concerns about the perceived credibility of accounts of people in asylum interviews, she added: ‘One of the reasons people are denied asylum is because their evidence isn’t considered credible… but what’s emerging is one of the reasons for this is that it wasn’t gathered appropriately in the first place.’

As a member of the Project Advisory Board for the charity Asylum Aid, Memon said she and her colleagues hoped to have an impact on Home Office training in this area. She quoted a judge: ‘“If you could teach people as part of their legal training how to interview and take a good statement you wouldn’t have the credibility problems we have”… all the evidence points the potential for research to have an impact in this area.’ ER For a link to the award video: www.esrc.ac.uk/newsevents-and-publications/impact-case-studies/protectingvulnerable-witnesses

the psychologist august 2017 news

Research digest

Moral judgements of terrorists

Dr Christian Jarrett for the Research Digest www.bps.org.uk/digest Read the article: tinyurl.com/ybcgv65e

Using purchase patterns from Amazon and Barnes & Noble, researchers have shown that left-wingers and right-wingers read very different science books. Liberals were drawn more to engineering, anthropology and purer sciences like biology and astronomy; conservatives to applied disciplines such as medicine and law, and – in the highest association for the them – climate science, although they tended to read a narrow range of sceptical books. (Nature Human Behaviour)

Alvaro Ybarra Zavala/Getty Images

After a terror attack, amidst the shock and sadness, there is simple incomprehension: how could anyone be so brutal, so inhuman? In Nature Human Behaviour, Sandra Baez and her colleagues offer rare insight based on their tests of 66 incarcerated paramilitary terrorists in Colombia, who had murdered an average of 33 victims each. The terrorists completed measures of their intelligence, aggression, emotion recognition and, crucially, their moral judgements.

On most measures, such as intelligence and executive function, there were no differences between the terrorists and 66 non-terrorist control participants from the same region. The terrorists admitted to more aggression, as you’d expect, and they showed difficulties recognising anger, sadness and disgust.

However, the most striking group difference concerned moral judgements on 24 different scenarios. Unlike control participants, the terrorists judged acts of intended harm with neutral outcomes (such as intending to poison someone, but failing) to be more morally permissible than acts of accidental harm (such as poisoning someone by mistake). In a follow-up, the terrorists also rated attempted harm as more morally permissible than accidental harm, as compared with a group of incarcerated non-terrorist murderers.

Baez and her team said this distorted approach to morality implies a problem with weighing intentions combined with an excessive focus on outcomes, and it is similar to the moral perspective taken by very young children and by adult neurological patients with damage to the frontal lobe and temporal lobe of their brains (but not by psychopaths, who do seem to weigh intentions when making their moral judgements).

‘The profile observed in the terrorists may reflect their fixation on utopian visions whereby only (idealised) ends matter. That is, their outcome-based moral judgements may be related to the belief that any action can be justified,’ the researchers said.

This research involved Colombian terrorists who had joined paramilitary organisations mainly for economic rather than ideological reasons. It remains to be seen if the specific deviant moral code uncovered in this research is also a characteristic of Islamist terrorists.

A promising avenue for future investigation, the researchers noted, will be to see whether careful tests of moral judgement could be used to predict likelihood of future offending in dangerous offenders; also to study whether and how radicalisation alters the nature of people’s moral judgements.

Psychology is a vast topic, and there’s a possibility that the findings from some subdisciplines may be more robust than others, in the sense of replicating reliably, even in unfavourable circumstances. A new paper has tested nine key findings from cognitive psychology, related to perception, memory and learning, and it found that all replicated, even when participants had been tested on the same effect before (available as a preprint at PsyArXiv).

Scientists’ facial appearance affects our perception of their work, but not in a straightforward way. Participants looked at photos of scientists and then rated their work.

They were more interested in the work of attractive scientists, but assumed it was lower quality. Those scientists who’d ranked lower for physical attractiveness and sociability generally got better scores for trustworthiness and competence. The level of bias uncovered in this research could have significant real-world implications, the researchers said. (PNAS) Your personality may affect your vulnerability to mental health problems. A new study of nearly 600 participants in Switzerland is the first to look simultaneously at people’s personality, life events and mental health problems as they unfold over time. Though they come with important caveats, the findings suggest that some people have a personality profile – especially high trait neuroticism and low extraversion – that predisposes them to mental health problems, to more serious mental health problems when they occur, and even to more adverse life events. (European Archives of Psychiatry and Clinical Neuroscience)

By Dr Christian Jarrett. These studies were covered, along with many more, by him, Dr Alex Fradera and Emma Young on our Research Digest at www.bps.org.uk/digest

False economy?

Heralded as a revolution in mental health care – a cost-effective way to deliver evidence-based psychological help to large numbers – low-intensity cognitive behavioural therapy (CBT) is recommended by NICE, the independent health advisory body in England and Wales, for mild to moderate depression and anxiety and is a key part of the Improving Access to Psychological Therapies programme in those countries.

Prior studies into its effectiveness have been promising. However, little research has looked at whether the benefits last.

A new study in Behaviour Research and Therapy has done that, following a cohort of people with depression and anxiety over time.

Disappointingly, the team led by Shehzad Ali at the University of York, found that after completing low-intensity CBT, more than one in two service users had relapsed within 12 months.

Low-intensity CBT is based on the same principles as full or highintensity CBT – clients reflect on and strive to change their habits of thought that could be contributing to their mental distress, and they also learn coping strategies and other skills. However, it’s delivered in such a way as to reduce the need for extended one-on-one time with a qualified psychotherapist. It typically incorporates self-help books and internet exercises, usually completed under the guidance of a ‘wellbeing practitioner’ or coach who is trained to follow a highly structured programme rather than having any formal psychotherapy training.

To test the longer-term outcomes for low-intensity CBT, Ali and his colleagues recruited hundreds of people at a primary care service in West Yorkshire in England. The participants were diagnosed with depression or anxiety, or both, and had enrolled in low-intensity CBT.

Some dropped out prematurely and were not included in further analysis.

For current purposes, the researchers were interested in the 439 participants who had recovered during their low-intensity CBT (improvements in their symptoms meant they no longer met the diagnosis for anxiety or depression) and who had ended their course of treatment in agreement with their practitioner or coach – on average this was after seven contacts with their practitioner, including the initial assessment. For comparison, highintensity CBT with a psychotherapist can last up to 20 sessions.

After finishing their low-intensity CBT, the recovered participants (average age 41, 60 per cent were female, over 90 per cent were white British) completed monthly questionnaires that measured their levels of anxiety and depression symptoms. As time went on, an increasing proportion of the

After-school psychology club Two researchers who developed an after-school psychology club for primary-school children have told us about their project, and shared their suggestions of what works when engaging with a much younger audience.

Experimental Officer Dr Susanna Martin and Eleanna

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Skoulikari, from the University of Bath’s CREATE Lab, also crowd-sourced some of their ideas for sessions through The Psychologist.

The CREATE Lab was contacted by a local primary school to develop an after-school psychology club and recruited postgraduate students from the Psychology Department to help. Each session was supervised

by Skoulikari, and the PhD students used their own research to come up with topics for each session along with complementary activities.

Each of the Psychology Club’s weekly meetings involved a short presentation by one or a pair of postgraduate researchers, followed by hands-on activities along a similar theme. For example, after the first week’s session pupils were asked to keep a dream diary, and the following week they had a go at dream analysis.

They also explored robots (and built their own), video games, optical illusions, emotions and stress.

In their ninth session, the pupils divided into groups and chose

the psychologist august 2017 news

participants showed evidence of having relapsed – that is, their symptoms had deteriorated to a point that suggested they were likely to be diagnosed as having anxiety or depression again. By 12 months after the end of their low-intensity CBT, nearly 53 per cent had relapsed; half of these relapses had occurred within two months, 80 per cent within six months. (For comparison, a metaanalysis of high-intensity CBT found that 29 per cent of recovered clients with depression had relapsed within 12 months, which is a better outcome than for patients who stop taking anti-depressants.)

Is it possible to predict who is likely to relapse? In the current study, recovered participants who still showed some symptoms of depression at the end of their course of low-intensity CBT (but not enough to justify a diagnosis) were far more likely to relapse over the ensuing year. Residual anxiety symptoms

were not predictive in this way. The finding for residual depression symptoms suggests many lowintensity CBT users would benefit from some kind of ongoing aftercare, such as booster sessions or other lower-intensity support.

‘It seems hasty to consider patients “recovered” at the point of discharge without assessing full remission symptoms over a longer period,’ Ali and his colleagues concluded. ‘It could be argued that many of the relapse cases in this study actually had partial (rather than full) remission at the time of treatment completion, and thus never actually “recovered”.’

The findings from this study will fuel the fears of some experts that low-intensity CBT may be quick and cheap, but that many people are being sent on their way before they are fully recovered. One counter to that argument is that prior to the roll-out of low-intensity CBT, many

of the kinds of people who took part in this research (i.e. people with mild to moderate mental health problems) would have received no treatment at all or been given powerful drugs. They might have spent months or years on a waiting list for a psychotherapist, during which time their problems may well have worsened. Another point to bear in mind was that this research was conducted in just one service in England, and more research is needed in other areas.

‘It is clear that relapse prevention is an overlooked aspect of routine stepped care in Improving Access to Psychological Therapies services and an important area for further policy and research developments,’ the researchers said.

Dr Christian Jarrett for the Research Digest www.bps.org.uk/digest Read the article: tinyurl.com/ y9qdy8dp

the pupils’ confidence grow, and their learning was very apparent when they were presenting activities to members of the public in a ‘teacher’ role.

The second term of Psychology Club also involved physics PhD students as guest presenters leading sessions on light and forces. At the end of each session pupils were asked to write positive and negative comments as feedback, Martin and Skoulikari said all the students had enjoyed the sessions and were disappointed to hear it would not be continuing due to a lack of funding.

However, they offered some tips for any other researchers interested in running a similar club. Martin said prior to embarking on a project like this it was vital to plan early, especially with regard to DBS checks for those working with children for longer stretches of time and building a good relationship with the school.

Skoulikari added that it was vital to be well prepared with equipment and resources, prepare hands-on sessions and back-up activities in case they take less time than anticipated, and use informal techniques to gather feedback from pupils. ER

activities they had learned to present to members of the public at the local Bath Taps into Science festival the following week. Skoulikari said it was amazing seeing

To read our original article crowd-sourcing ideas for Martin and Skoulikari’s sessions see tinyurl.com/ybt5tyg4.

If you started a ‘Psychology Club’ after reading that, let us know how it went.

Does the cycle of violence truly cycle?

Professor Cathy Widom

Next year’s Division of Forensic Psychology Annual Conference is on 19–21 June at the Hilton Newcastle Gateshead.

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Erwin James

When we speak about the cycle of violence we make many assumptions, said Professor Cathy Widom (John Jay College of Criminal Justice and Graduate Centre, City University New York) in the first keynote at this Annual Conference of the British Psychological Society’s Division of Forensic Psychology. But is it truly the case that violence leads to violence, with such behaviour transmitted through the generations?

In the 1960s, Widom said, clinicians began to find an association between violence in young people and a history of sexual abuse. Later, in the 1970s, crosssectional studies of delinquent children and patient groups began to emerge. However it wasn’t until the 80s that researchers began to trace the life courses of young children who were abused and neglected. These longitudinal studies showed an emerging picture of the link between neglect and violence.

Widom’s own prospective longitudinal study used 908 court-substantiated reports of neglect and abuse that happened between 1967 and 1971, and tracked their rates of violence looking at arrest records over the next 25 years. These were compared with a control group matched on age, race, sex and their family’s socioeconomic status. Later she and her colleagues conducted interviews with participants and their children to assess

whether neglected and abused children treat their own offspring in the same way.

In 1994, when participants had a mean age of around 32, Widom found both physically abused and neglected children to have the highest number of arrests for violent crimes. Widom pointed out neglected children are often ignored by researchers and the public, but neglect represents around three quarters of US Child Protective Services (CPS) cases. Those who were sexually abused as children had slightly lower levels of arrests for violent crimes, while those who had experienced multiple types of abuse had similar arrest levels to those of the control group – perhaps due to CPS becoming involved with these children at an earlier age. Around 20 years later the cohort of adults showed the same pattern, albeit now with more arrests among them – the highest level of arrest was in the neglected group, followed by physical abuse.

Widom said the context behind such data reveals how complex something like the so-called ‘cycle of violence’ is. For example, there are substantial racerelated differences – while black people are much more likely to be arrested, abused and neglected, black children report much less violence than white abused and neglected children. The cycle of violence model has also perpetuated a belief that girls tend not to externalise their

Don’t ask whodunit, but whydunit Forensic psychologists recently joined forces with the National Union of Journalists in an event to challenge the way in which crimes, and criminals, are reported in the media. During the Division of Forensic Psychology Conference, a panel including Vice Chair of the DFP Dee Anand and convicted murdererturned-Guardian-columnist Erwin James turned their attention to psychologists. They asked how the media and clinicians can work together to improve the narratives within crime reporting.

Anand stressed the role of psychologists in changing narratives about criminals.

He added that the media tends towards portraying offenders as having a debt to society, but it was important to remember these crimes happen, and individuals live within, a society. It is society, he added, that needs to take responsibility for offenders not

vice versa – it is in this way we can begin to change.

Lawrence Jones, a Consultant Clinical Forensic Psychologist, said the stories often hidden behind crimes are in the public interest as they highlight failures in society that lead to serious offending. While trauma is not an automatic precursor to becoming a criminal and is not an excuse for crimes, he added, it was important to think about context in reporting on crimes. Offenders have often experienced a whole cascade of trauma throughout life and not a single event. These stories need to be heard, Jones said, especially when we consider the denial or rejection of historic child sex abuse which has recently come to light.

Mail on Sunday Investigative Reporter David Rose gave the journalist’s perspective on this. He started by outlining the fact that ‘the media’ isn’t a one-bodied manyheaded beast consisting of a shared goal. Rose acknowledged that

ethics may prevent many forensic psychologists from speaking out about the context behind individual offenders, but there are ways to work well with journalists. He said journalists are desperate for information at a time where the pressure on them to come up with content is greater than ever. He said: ‘If you give them access to people and information they will cherish you, and the last thing they want to do is write things to annoy you.’

He said while people speak of certain things being ‘typical in the media’ the best way to combat this is putting across a different side with the media. He said while the process of bringing journalists into the realm of forensic psychology wasn’t clear it was still possible to change the way things were done.

Professor Peter Kinderman, Vice President of the BPS, emphasised a need to present people as responsive individuals who are taught by the world how best to respond to things.

the psychologist august 2017 news

The Division of Forensic Psychology Annual Conference took place in Bristol anger, but Widom’s work has shown that, compared with controls, girls who were abused and neglected have more risk of arrest as a juvenile and an adult and for a violent crime.

Another common assumption is that children who were sexually abused as children go on to become sex offenders – but data disputes this. Those children who were neglected or physically abused are at increased risk of sex offending, which isn’t the case for children who were sexually abused. Research in Australia showed around 3 per cent of sexually abused boys went on to

become sex offenders and of those who committed a sexual offence 82 per cent had no history of maltreatment and 96 per cent had no history of sexual abuse.

Do parents with histories of abuse or neglect abuse their own children? Many studies have looked into this through self-report, but Widom pointed out that not many parents would be willing to admit to abusing their child.

In her longitudinal study, she asked the children of the cohort about their own experiences of abuse and neglect.

Her interviews found having a parent with a history of maltreatment leads to an increased risk of being reported to CPS. The offspring of these parents also had an increased risk of experiencing neglect, maltreatment and sexual abuse – but not physical abuse.

Widom said that while a cycle of violence exists, it isn’t inevitable, and that neglect is as damaging as physical and sexual abuse but has had little attention paid to it.

She also suggested that violence prevention policies need to target maltreated girls as well as boys, and potentially the policies aimed at children who were sexually abused need to be re-evaluated, as this group isn’t that likely to go on to become sex offenders. Unsupported assumptions lead to harmful social policies, she added, as well as ineffective screening tools, worker bias and poor outcomes for children and families. ER

EMDR to help tackle PTSD The idea of offending behaviour stemming from the function of the brain, rather than social circumstances, isn’t backed up by data, he added.

Kinderman said it was vital to understand what has happened to people and find out why they respond in the way they do. The problem for psychologists, he added, was to explain these inherently complicated ideas in a straightforward way. He set a challenge for journalists: ‘Tell your readers what they aren’t expecting to hear, challenge them to open their minds about why people might commit crime.’

Erwin James, who served 20 years of a life sentence for two murders and began writing a column for The Guardian from prison, said he had never expected he would be standing up and speaking at a conference such as the DFP’s.

James said when he was taken away from the Old Bailey he felt his life was over, and he was glad.

He was first convicted of a crime at the age of 10, and by the time he was convicted of murder had 53 convictions to his name. During his time in prison James listened more and more to current affairs programmes, heard discussions of crime and punishment and began to see the world differently. After meeting a forensic psychologist he began to realise he had no choice over the life and circumstances he was born into.

‘I wasn’t born bad. We’re all born loveable. We’re all born with the potential to be who we were meant to be,’ he said. As someone on the receiving end of the media’s wrath James, who is now a Trustee of the Prison Reform Trust, emphasised the importance of understanding the stories behind crimes. He added that most people do not understand the reality of life behind bars, nor do most criminals want to hurt people.

If we don’t give them a chance, he added, society is less safe. ER

While many believe paedophilic tendencies are a fixed state clinical psychologist Dr Lisa Wright (Mersey Care NHS Foundation Trust) spoke of one case study where EMDR therapy (Eye Movement Desensitisation and Reprocessing) had reduced a client’s sexual interest in children.

Treatment programmes for sex offenders, she said, usually use CBT, but when this desire is linked to a traumatic experience EMDR may be useful.

‘J’ was 27 years old and had been convicted of sexual assault against two boys aged seven and nine. J had PTSD from suffering abuse at the hands of a neighbour between the ages of seven and nine and was receiving EMDR to help tackle his PTSD symptoms.

Wright said that a year after his EMDR J’s intrusive memories, nightmares and flashbacks had all vanished. But interestingly he no longer experienced sexual arousal around children and his sexual desire towards adult females had become stronger. Wright said although this wasn’t the aim of therapy, it was a noteworthy outcome and therapists should consider the origins of sexual attraction to children when choosing the right therapy. ER

The future of transport?

The psychology of self-driving vehicles, with Stephen Skippon and Nick Reed

Self-driving or autonomous vehicles (AVs), once the stuff of science fiction, are poised to become reality. Automotive manufacturers are progressively automating more and more aspects of driving, leaving less for human drivers to do, and non-traditional entrants like Google and Apple aim to leapfrog to fully self-driving road vehicles.

How can psychology inform the transport of the future?

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magine a society where all road travel was in self-driving vehicles. It might look very different to today: with many fewer deaths and injuries, the disappearance of some social practices, and the emergence of new ones. Back in 2005 Frank Geels pointed out that transitions like this are never purely technological in nature: they are ‘sociotechnical’. The ways people are affected by, respond to, and attribute meaning to technologies matter as much as the technologies themselves. As psychologists, we at the Transport Research Laboratory (TRL) in Wokingham have a slightly different take on Geels’ concept and see them as psychosocial-technical transitions. Neither the dynamics of a transition nor its consequences can be understood without exploring the psychology of people affected.

TRL, a former government research institution now owned by the non-profit-distributing Transport Research Foundation, began researching automation of driving in the 1960s. Along with other transport researchers in the UK and abroad, our Transport Safety and Behaviour Group is actively involved in exploring some of the psychological implications of the transition from human-driven to automated vehicles.

A central practice Driving is a central social practice in many societies.

It’s both a functional means to engage in modern life and a means to create and reflect personal identity. Researchers and policy makers who refer to ‘car-dependent’ societies are implicitly also discussing driving-dependent societies.

Driving offers many benefits, and few who drive are willing to give it up, yet it has huge costs for societies.

Mass car use degrades local and global environments, and, uniquely among means of travel, it causes large numbers of deaths (1730 in the UK in 2015) and serious injuries (22,144 in 2015) with distressing and traumatic consequences that ripple out to people beyond those immediately involved in each crash.

The transition to self-driving vehicles could change all that. Human error is the sole cause of most

the psychologist august 2017 driverless cars Ciaran Murphy/ciaranmurphyillustration.com

crashes. Full automation is potentially much safer, since AVs don’t get tired, distracted or impaired by alcohol and drugs, don’t get angry, and don’t choose to take inappropriate risks. Their widespread use could also potentially reduce congestion, improve air quality, and cut damaging carbon emissions. They could bring personal benefits too – while many enjoy the experience of driving, there are many who see the attraction of being able to hand over the driving task and occupy themselves with other activities, much as rail travellers do. AVs could even enable people

currently unable to drive to have the benefits of independent, point-to-point personal travel for the first time.

We’ll explore some of the psychological dimensions of this transition by considering three scenarios.

First, automation of driving on multi-lane highways is just around the corner, in the form of ‘auto-pilot’ functions that can be selected by human drivers on these roads. We’ll compare psychological theories of how human drivers drive on these roads to the ways in which AVs are being designed to do it. Second, we’ll

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other. For instance, safety and rule-following goals outline the extra complexities of automating driving might exert complementary restraining influences in urban centres. The GATEway project led by TRL on speed, while the goal to experience pleasure from (www.gateway-project.org.uk) is one of three projects commissioned in 2014 by the UK government through driving might exert a conflicting influence.

Evidence is also emerging that symbolic goals innovation agency Innovate UK, with support funding to signal aspects of personal identity are relevant. from commercial partners, to research the potential TRL research in our DigiCar driving simulator has for integration of AVs into society. In the project, we found that driving styles correlate significantly intend to trial fully self-driving shuttle minibuses in with the five-factor personality traits agreeableness, a public, non-road urban environment to investigate conscientiousness and neuroticism. their interactions with pedestrians, We have also found that driving cyclists, etc. Third, we’ll consider “Human driving style signals these personality traits the so-called ‘moral algorithm’ to others, and we have observed problem – how would an AV performance is readily drivers changing driving styles ‘decide’ in an emergency between impaired by tiredness, in response to the gender of a two alternative behaviours, each mood, alcohol, drugs previously unknown passenger. of which could cause harm to It seems likely that at least some humans? and various distractions of the reason for risky driving like mobile phone calls styles and rule violations is the and texting” opportunity they afford to signal Motorway driving aspects of personal identity to Human driving can be understood others. in terms of self-regulation processes AVs, by contrast, are controlled by software. in which behaviour is controlled, through feedback For less complex driving environments, that software mechanisms, in the pursuit of target reference states need not be too complex, at least at high level, where or ‘goals’. A feedback mechanism features a mental control is exercised by a ‘finite state machine’ that comparator that compares the perceived state of the represents the various possible behavioural states world with the reference state, detects discrepancies, available to the vehicle (see Özgüner et al., 2011). and activates behaviours to reduce them.

For adaptive cruise control, available in cars today, Ray Fuller’s risk allostasis theory (RAT) elaborates the system remains in one state, ‘cruise’, until a on this to propose that task difficulty, experienced as switching condition is detected – such as the presence ‘feelings of risk’, is self-regulated of a slower-moving vehicle ahead. It then switches to in driving. ‘Allostasis’ means that another state, ‘slow down’, which is maintained until there is not a single target level of Key sources speed is matched to the leading vehicle and following feelings of risk, but rather a target distance is appropriate for that speed. Then it switches range of levels. If feelings of risk are Flach, P. (2012). Machine learning: The to a third state, ‘follow’, which is maintained until too strong, or not strong enough, art and science of algorithms that make some further switching condition is encountered. driving behaviours such as speed sense of data. Cambridge: Cambridge Adaptive cruise control cancels if the driver manually selection are adjusted to return University Press. brakes or accelerates. When more aspects of driving Floridi, L. (2014). The 4th revolution: How them to the target range. RAT also the infosphere is reshaping human reality. are automated, different general driving situations includes a secondary mechanism in Oxford: Oxford University Press. (or ‘metastates’) each have their own finite state which dispositions to comply with Fuller, R. (2011). Driver control theory. machines, and in complex situations there may be speed limits, and influences such In B.E. Porter (Ed.) Handbook of traffic hierarchies of state machines, each representing as enforcement measures, combine psychology. Amsterdam: Elsevier. with the output of the feedback loop relevant families of situation-appropriate behaviours.

Geels, F. (2005). Technological On a motorway the range of potential behavioural transitions and system innovations: A coto determine the speed the driver evolutionary and socio-technical analysis. states for a vehicle is limited and readily represented adopts.

Cheltenham: Edward Elgar Publishing. in software. The software also needs to contain RAT may not be the whole Özgüner, Ü., Acarman, T. & Redmill, representations of all possible situations (specific answer.

In Heikki Summala’ s (2007) K. (2011). Autonomous ground vehicles. configurations of sensor inputs) that require a change multiple comfort zone model, Norwood, MA: Artech. from one state to another. The set needs to include drivers seek to keep several control Summala, H. (2007). Towards all the potential switching conditions in which the understanding motivational and variables within ‘comfort zones’: emotional factors in driver behaviour: safety, trip progress, rule compliance safety of occupants and/or other road users requires Comfort through satisficing. In P.C. a response – such as the presence ahead of stationary (traffic laws, social norms), smooth Cacciabue (Ed.) Modelling driver objects, slower-moving vehicles, or vehicles changing operation and performance, and behaviour in automotive environments: lanes ahead. For motorways this is still a relatively pleasure of driving. A particular Critical issues in driver interactions with small, manageable set, which is why automation of behaviour such as speed selection intelligent transport systems. London: motorway driving is already within reach.

Springer-Verlag. is the result of the combined So who’s best when it comes to this task? Human influences of these multiple Full list available in online/app version. driving performance is readily impaired by tiredness, goals, some complementary, some competing and conflicting with each mood, alcohol, drugs and various distractions like

the psychologist august 2017 driverless cars

mobile phone calls and texting.

We suggest that it’s also influenced by symbolic goals that lead some to adopt risky driving styles. On UK motorways, around half of human drivers break the speed limit, and ‘tailgating’ – following dangerously close to the vehicle ahead – is commonplace. AVs won’t have any of those limitations so it’s easy to see how a transition to fully automated driving on motorways could save many lives. There are likely to be substantial reductions in congestion and emissions, too.

We’re confident AVs will soon be winning this one hands down.

Urban driving: it’s complicated…

It’s not so easy to automate driving in urban areas.

To a roboticist these are ‘unstructured’ environments that have not been specifically designed for automated operation and contain unpredictable elements – particularly people, doing unpredictable things in unpredictable ways. Although the range of behavioural states a vehicle can adopt is still quite limited, no matter how many switching conditions are considered there’s always the possibility of something new happening. A few days ago in a North Wales village, while being tailgated, one of us encountered the lifesized figure of a person made entirely of silver balloons slowly drifting across the road ahead.

When human drivers encounter situations never previously experienced, their responses are whatever behaviours are most simultaneously consistent with their presently active goals. The unusual balloon situation was easy enough for a human driver to handle by reference to the active goal of remaining safe – recognising that the figure wasn’t a person, this was best met by continuing forwards without slowing.

An automated system, however, can only respond to a novel situation to the extent that its sensory inputs fit closely enough to one of its switching conditions to trigger a change of state. The problem is that the range of possible situations in an unstructured environment like an urban centre can be huge, and the possibility of a silver-balloon situation is always there. To tackle this, designers of self-driving vehicles are now pursuing approaches based on machine learning: algorithms that improve their performance with experience. In machine learning, the AV is presented with a training set of environmental conditions (sensor inputs), and the correct responses to each. The AV gradually builds its own associative model of what combinations of sensor inputs determine switching from one behavioural state to another. Potentially the model can be continuously refined as further experience is gained.

Much of the present effort in AV software development consists of the acquisition of very large training

Stephen Skippon is a Principal Human Factors Researcher skippon@trl. co.uk

datasets from vehicles operating in real-world road environments.

For the future, there is the potential for every AV to ‘learn’ from the collective experiences of all.

In machine learning, humans Nick Reed are still indirectly influential in is Academy defining how the system makes Director at TRL decisions, by specifying the nreed@trl.co.uk appropriate actions in the various training conditions. Without this human feedback, a self-driving car cannot ‘learn’ in a meaningful way.

Further, it may be that the training appropriate for one driving environment (in the USA, say) may not be appropriate for another (Germany, India, Japan, UK) where road networks, driving traffic laws, and driving cultures are different. Humans may need to provide different training datasets and guidance on appropriate decision-making for each distinct environment.

Nevertheless there is always the possibility of something happening that an AV can’t fit reliably to anything in its database. AVs could be programmed to err on the side of caution in such cases – for instance, slowing down – but it may still seem that the ability of an AV to respond to novel situations in urban driving will be more limited than that of a human driver.

So what justifies the claim that a transition to AVs could reduce or even put an end to crashes in urban driving? First, as discussed earlier, the performance of an AV does not degrade through tiredness, or the influence of drugs or alcohol: it operates the whole time at peak alertness and with peak response times.

Second, its attention is always fully on the driving task: it’s never distracted by a conversation, texting, or anger at a recent aggressive encounter. Third, it has no attentional blind-spots. Fourth, its driving ‘style’ is consistent, exactly as programmed, and predictable by other road users. For these reasons, an AV is much less prone to lapses, and not at all prone to deliberate violations in its driving. These are potentially enormous advantages from a safety perspective.

Can we entrust moral choices to AVs? Our final scenario is the so-called ‘trolley problem’ – an emergency situation where an AV must choose between two courses of action, each of which would cause harm to or the death of one or more humans. This is one of the most contentious topics in discussion of AVs. How could an AV make a morally appropriate choice?

From a psychological perspective, an obvious challenge to the trolley problem is to ask, how often

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do human drivers face it? If you drive, ask yourself whether you’ve ever experienced it yourself: very few drivers ever will in a lifetime of driving. Is it something a particular AV realistically will ever face?

If your answer to that question is yes, then consider next how human drivers might respond to this emergency. Some drivers may not even notice it, if their attention is distracted by a phone call, bored children in the back seat or any of the other sources of driver distraction. Others may notice, but be unable to make any choice in the time available: for instance if their reaction times are extended through fatigue, alcohol or drugs. Among those who are able to make a meaningful decision in time to act, there is still no Greater autonomy is being gradually introduced by vehicle guarantee that they would make a choice that was manufacturers generally considered morally appropriate within their culture. Social psychology has shown us that people often carry explicit or implicit prejudices, valuing some some potential benefits. For instance, the perceptual systems of AVs can be made agnostic to visual people more highly than others based on race, gender, details like skin colour, gender, age or body shape religion, age, etc. People are also influenced by recent that might activate prejudicial responses from some experience: might a furious row with a partner just humans. Importantly, there is the before setting off lead someone potential for societies to exercise to implicitly devalue the life of “How could an AV control, insisting on standards someone else who shares visual and regulations that require the characteristics with the partner? make a morally implementation of choices that Then there’s self-interest. It can be appropriate choice?” reflect what is currently socially argued that human drivers often acceptable. That might deliver make ‘immoral’ choices: speeding outcomes that are more socially and tailgating, for instance, acceptable than those that might be made by many implicitly involve choices to put self-interest ahead human drivers, with all their issues. of the safety of others (remember that risky driving correlates with low trait agreeableness). Emerging evidence already suggests that AV users would want Where next for psychology and AVs? them to prioritise the safety of the vehicle’s occupants Current psychological interest focuses on the transition over that of people outside. from human to autonomous driving, during which Therefore in thinking about how an AV would both types of control will coexist. They already do: tackle the trolley problem it’s a mistake to assume adaptive cruise control has been available for some that they would necessarily be worse at it than years. Greater autonomy is being gradually introduced human drivers. by vehicle manufacturers: Tesla’s Model S car has an How then would an AV respond to an emergency ‘Autopilot’ automated driving functionality for highway situation that involved the trolley problem? It would driving such that the driver need not normally interact switch between behavioural states if a switching with steering or pedal controls. condition were met. Those switching conditions So far this autonomy is only partial. The human will have been programmed, directly or indirectly, driver remains responsible, and (according to the by humans. Even in machine learning, where the Tesla owner’s manual) must ‘stay alert, drive safely, software builds its own switching model through experience, it is ultimately told the correct behavioural ensure the vehicle stays in the traveling lane, and be in control of the vehicle at all times’. How realistic is response to each situation in its training set by a it to expect human drivers to do this? How long will human. It’s up to human trainers and programmers it take a human driver who’s doing something else to make the moral choices in advance and to provide to respond to an alert, re-orient themselves to the sufficient learning experiences to build an appropriate driving situation, and decide what do? What happens model. The AV software will implement that model as automated systems get better, so the frequency with of human choices if it ever encounters a genuine which humans need to intervene becomes lower? trolley problem.

Will drivers eventually become so de-skilled through There are risks in this. For instance, knowing that AV users would prefer an AV that prioritises their safety inexperience that their interventions are unsafe?

These are all topics of immediate research interest over that of others outside, might manufacturers be for transport psychologists, and driving simulators tempted to bias the programming or training of AV like DigiCar provide us with safe virtual-reality in that direction? Would that fit with or contradict environments in which to study them. socially accepted moral values? However, there are

the psychologist august 2017 driverless cars

During any transition, human drivers will share the roads with AVs. The ways that they respond to AVs in this mixed environment could potentially have major impacts. Some human drivers may adapt their driving behaviours in relation to AVs – for example feeling safe to change lanes into the path of an AV. If that became common there could be significant adverse effects on traffic flow dynamics and road safety. Potentially, highways authorities will need to introduce specific measures and structural features to manage adverse impacts of some interaction styles.

The presence of AVs will also influence how pedestrians and cyclists interact with vehicles. In busy urban areas with slow-moving traffic, it is not uncommon for non-verbal communication to take place between pedestrians and drivers. In the absence of human drivers, AVs may need to adopt new forms of communication to indicate their intent to pedestrians.

Similarly, pedestrian behaviours may adapt to automated vehicles in the knowledge that, within the capabilities of its braking performance, an automated vehicle will certainly stop for a pedestrian in the roadway. We intend to investigate such interactions in the GATEway project.

In the 2014 book The 4th Revolution: How the Infosphere Is Reshaping Human Reality, Luciano Floridi has pointed out that successful automation typically

involves ‘enveloping’ the system in an environment adapted to its particular strengths and weaknesses (ability to rapidly process large amounts of data, but inability to perform semantic, meaning-related tasks): ‘If driverless vehicles can move around with decreasing trouble…this is…because the “about” they need to negotiate has become increasingly suitable for light AI [artificial intelligence] and its limited capacities.’ Enveloping AVs in a suitable environment could involve simplifying their perceptual tasks, for instance by adding inexpensive radio frequency ID tags to other vehicles, road signs and fixed roadside objects. It might also involve adapting road traffic laws to their capabilities; and ultimately, the adaptation of human road users’ responses to them. A transition to full autonomy may be enabled more readily if progress in AV machine learning is accompanied by such adaptations to the operating environment.

Taken together, these developments may lead to significant changes in the way we are able to achieve mobility in future. However, none of them are simply technological developments. All involve interaction with people, and understanding of those interactions is just as important as engineering the technologies. Our in-depth understanding of the psychology underlying human interactions with AVs will be critical to their ultimate integration into society.

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The hidden costs of working when sick Mariella Miraglia and Gail Kinman review the evidence on presenteeism

Have you ever struggled into work when you felt sick enough to stay at home? If so, you are one of the 43 per cent of European workers (according to a 2012 Eurofound survey) who have engaged in presenteeism. People work while sick for several reasons, such as excessive job demands, a sense of obligation to their employers or service users, and fear of job loss. Some may choose to work while sick because they enjoy their job too much to take time off.

Although presenteeism is commonplace, scholarly interest in the phenomenon only emerged in the late 1990s but it is now increasing rapidly.

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ack in 2010 Gary Johns traced the development of interest in presenteeism and highlighted the many ways in which it has been defined. Overall, two themes emerge: first, presenteeism is seen as the practice of attending work in spite of illness or injury; second, it is used to describe the productivity loss resulting from employees working while unwell and unable to perform to their full capacity. This perspective tends to be used in the field of occupational medicine, where attempts are made to quantify the productivity loss of presenteeism related to illness in general, or to specific medical conditions, such as coronary heart disease, arthritis and depression. Although it is vital to raise awareness of the financial costs of presenteeism, the validity of defining the concept in this way is questionable, as it confounds the cause (i.e. the behaviour of working when sick) with the effect (i.e. impaired productivity).

This does not allow researchers to identify the underlying reasons why people work while sick and the wider implications of this phenomenon.

Notions of the ‘ideal worker’ as one who shows their dedication and commitment by continuing to work while sick are being challenged, as knowledge of the incidence and costs of presenteeism has increased.

Most of the research has been conducted in North America and Australia, but UK researchers for the Sainsbury Centre for Mental Health have estimated that employee presenteeism is between 1.8 to 10 times more frequent than absenteeism. Working while unwell is thought to cost the UK economy almost twice as much as absenteeism (not being at work

the psychologist august 2017 presenteeism

Why do people work while sick?

• • • • • • • • • • • • • • •

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when unwell); indeed, a recent study calculated that presenteeism from mental ill health alone costs UK employers more than £15 million per annum.

There is also evidence that working while sick might be becoming more common. A 2015 survey of 600 UK businesses conducted by the Chartered Institute of Personnel and Development indicated that more than one employer in three reported an increased incidence of presenteeism among their staff in the previous year.

Manuel Faba Ortega/Getty Images

• • •

Stress Lack of support from colleagues/ interpersonal conflict Job insecurity Lack of support from supervisors Strict absence policies and sanctions Low job control Anti-sickness culture/norms; discrimination Management pressure Lack of sick pay Short staffing; lack of cover Financial difficulties Fear of burdening colleagues Low perceived employability Feeling responsible, irreplaceable and indispensable High job demands, particularly heavy workload and high time pressure Strong sense of duty and responsibility Long working hours culture Enjoyment of work; high commitment and engagement Understaffing/downsizing Demographics: women, high educational level

Why do people work while sick?

A wide range of contextual and individual difference factors has been found to contribute to workplace presenteeism (see ‘Main causes of presenteeism’).

Miraglia and Johns (2016) recently investigated the main drivers of presenteeism by synthesising the findings of 61 studies, with a total of 175,965 employees from several countries. Support for a dualprocess model was found, whereby presenteeism was predicted by positive as well as negative factors. The first pathway is via health impairment and stress,

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resource that can discourage presenteeism is control. where people work during sickness due to pressure There is some evidence that individuals who feel more of work and a lack of job and personal resources. The in control of their job typically feel less pressure to second pathway is attitudinal/motivational, where work while sick, but findings are inconsistent. Job people who are deeply committed to their job may be control encompasses a wide range of factors, and it is more inclined to ‘go to the extra mile’ and continue to likely that some aspects may be more protective than work when unwell. others. For example, schedule flexibility (the ability Factors such as high work intensity, job insecurity to control where and when you work) may enable and lack of support from supervisors and colleagues people to work from home when they feel too sick to have been found to encourage presenteeism. The physically attend work. The role most important constraints on played by adjustment latitude – the absenteeism, however, appear to “Organisations often use opportunity people have to reduce be strict attendance management or adjust their efforts at work – policies, such as limited entitlement a ‘trigger point’ system, has also been highlighted. High to uncertified absence days, a where employees are adjustment latitude may reduce lack of entitlement to sick pay, penalised after a threshold the likelihood of presenteeism, as or threats of disciplinary action. employees who are feeling below Organisations often use a ‘trigger level of absence is par may be able to choose the point’ system, where employees are reached” work tasks they feel better able to penalised after a threshold level of fulfil, reduce their cognitive effort, absence is reached. Consequently, decrease their pace of work, or take individuals may continue to more breaks. work while unwell to avoid being punished by their As working conditions and job characteristics employers, especially if their jobs are insecure, they are vary according to occupational group, it is perhaps experiencing financial difficulties, or there are fewer unsurprising that the factors that predict presenteeism options for alternative employment. are likely to differ. A mixed-methods study of UK The roots of presenteeism also lie in job design. prison officers conducted by Kinman and colleagues Arnold Bakker’s Job Demands–Resources (JD–R) (2014, 2016) found that more than eight out of model stipulates that job resources can offset the ten participants felt pressurised to work while sick. negative impact of job demand. Demands such as A combination of job demands, low control, poor heavy workload, time pressure and understaffing may support from managers and interpersonal conflict induce people to work excessively long hours – even were the strongest predictors of presenteeism. The if they are sick – in order to deal with a high volume qualitative data highlighted a range of other factors of work and meet tight deadlines. that encouraged officers to work during illness such The risk of presenteeism may also Key sources as an ‘anti-sickness’ culture, management pressure, be exacerbated if employees have job insecurity, staff shortages, fear of letting colleagues fewer resources to draw upon. down and a strong sense of duty. Fear of referral to Drawing on Hobfoll’s conservation Demerouti, E., Le Blanc, P.M., Bakker, external absence management providers and the likely of resources model, employees who A.B. et al. (2009). Present but sick: A three-wave study on job demands, penalties was also a strong driver of presenteeism. are taxed by high demands at work presenteeism and burnout. Career A tendency to work while sick also seems may use all their available resources, Development International, 14, 50–68. particularly common within health and social including continuing to work when Johns, G. (2010). Presenteeism in the ill, to avoid any further resource loss care workers. A 1997 study of UK doctors led by workplace: A review and research McKevitt found that more than 80 per cent of and maintain productivity. As we’ll agenda. Journal of Organizational participants had continued to work through illness. discuss later, attempting to comply Behavior, 31, 519–542.

Kinman, G., Clements, A. & Hart, J. This strong attendance pressure felt by members of with excessive demands in this way (2014). Work-related wellbeing in the the so-called ‘helping’ professions is likely to arise is likely to exacerbate strain and Prison Service. POA Publications. illness, increasing the risk of further from a combination of factors. Health and social care McKevitt, C., Morgan, M., Dundas, R. & employees typically have a high workload, work long presenteeism and the likelihood of Holland, W.W. (1997). Sickness absence antisocial hours, often under challenging conditions, sickness absence over the longer and ‘working through’ illness: A and are at a higher than average risk of job-related term. comparison of two professional groups.

Journal of Public Health Medicine, 19, On a positive note, job resources stress and burnout. They also tend to work within 295–300. cultures that emphasise the meaningfulness of the role may help prevent presenteeism.

Niven, K. & Ciborowska, N. (2015). The and inculcate a strong sense of responsibility for the Workplace support has been hidden dangers of attending work while welfare of vulnerable people. All these factors are likely found to reduce it; supervisors unwell: A survey study of presenteeism to encourage employees to continue to work while and colleagues may encourage among pharmacists. International sick. Working cultures that encourage employees to individuals to take time off sick Journal of Stress Management, 22, 207–221. neglect their self-care and consider sickness to be a when required, and their work may sign of weakness and a burden for colleagues will also be reallocated among the team or Full list available in online/app version. encourage presenteeism. The risks for the wellbeing temporary staff may be recruited of service users from such attitudes and behaviour, to provide cover. Another job

the psychologist august 2017 presenteeism

health and safety of others have been examined. There is evidence that people who are working under par tend to make more slips and lapses of judgement.

What is the impact of Studies of healthcare workers have presenteeism? associated presenteeism with an Working during contagious illness increased risk of patient falls and can obviously threaten the health medication errors. Such risks are of co-workers and members of well illustrated by a 2015 study the public. In the short term, of UK pharmacists conducted by however, continuing to attend Niven and Ciborowska. Employees work while sick may be desirable who worked while sick tended for organisations; the individual is to make errors more frequently, still ‘on the job’ and able to perform such as giving a patient the wrong according to the limitations of medication or prescribing the their medical condition. When wrong dosage. They also reported illness is neither overly debilitating higher levels of depression and nor contagious, there is some anxiety than those who took time evidence that the benefits of going Mariella Miraglia off sick. The authors maintained to work for employees might is at Norwich Business School, that working while unwell outweigh the costs. This view is University of East Anglia requires more effort to meet the supported by a study of over 2000 m.miraglia@uea.ac.uk required standard of performance, individuals affected by chronic as employees need to increase occupational musculoskeletal Gail Kinman concentration to overcome the disorders conducted by Howard is at the University of Bedfordshire distracting symptoms of illness, and colleagues (2009). Employees Gail.Kinman@beds.ac.uk such as pain. As this requires who were designated ‘presentees’ cognitive effort, the capacity to were more likely to complete a monitor and respond promptly to functional restorative treatment environmental demands is constrained, therefore programme and return to work full-time than those increasing the likelihood of errors and accidents. who took more sick leave. Working while sick might also be seen as an example of organisational citizenship behaviour and a sign of commitment and loyalty to the What can be done to address presenteeism? organisation.

Few organisations take any steps to discourage Although working while sick may have some employees from coming into work when sick. benefits, at least in the short term, a review of the literature shows that it can be damaging for employees Although it was generally acknowledged that presenteeism had increased and was a cause for and organisations. First, presenteeism can be a major concern, 56 per cent of respondents to the CIPD’s threat to long-term wellbeing. There is evidence absence management survey admitted taking no that working while sick is a risk factor for future action to reduce it. Of particular concern was the adverse health events, including cardiovascular finding that just under half indicated that operational disease and mental health problems such as anxiety demands tended to take precedence over the health and depression. In turn, this increases the risk of and wellbeing of their employees. As presenteeism subsequent absenteeism as recovery will be threatened is complex and multi-determined, interventions and health decline accelerated. A 2009 study of at multiple levels will be required. To begin with, nurses in the Netherlands led by Evangelia Demerouti examined how working while sick can increase the risk organisations should take steps to identify the incidence of presenteeism and assess its impact on the of burnout over time. Burnout is a chronic syndrome health and productivity of the workforce. This will in response to excessive work stressors that is raise awareness of the need to intervene. characterised by emotional exhaustion, together with Although most companies have systems in feelings of depersonalisation and reduced personal place to record and manage employee absence, accomplishment. A reciprocal relationship was found it is considerably more challenging to measure between presenteeism and emotional exhaustion, indicating that working while sick increases emotional presenteeism. Working while unwell may be invisible; not always disclosed by employees and difficult exhaustion that, in turn, increases the likelihood of to detect by even the most sensitive managers and presenteeism. Working while sick was also found to colleagues. Moreover, at what point does somebody intensify feelings of detachment from the job role, become a presentee? People frequently feel ‘off colour’, possibly in an attempt to recover from the emotional but not sick enough to take time off. As perceptions of demands of the job. health are highly subjective in nature, relying on selfThe implications of working while sick for the as well as the long-term health of professionals themselves, are clear.

Getty Images

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reports of presenteeism and judgements of its impact on job performance would seem inevitable, but the risk of confounding factors, such as negative affectivity and health anxiety, should be acknowledged. Staff wellbeing surveys could ask employees whether they have worked while sick over a specified period and, if so, to estimate the number of days they have done so.

Alternatively, employees to recall any health problems that occurred over the past year and then indicate whether they took time off sick or continued to work.

In this way, organisations could keep records of health and resulting attendance behaviours (i.e. absenteeism and presenteeism). Whether demographic factors or characteristics of the job predict presenteeism could also be examined. These methods could also be supplemented by measures of productivity loss related to presenteeism, such as the Stanford Presenteeism Scale (Koopman et al., 2002), that captures the impact As we’ve discussed, presenteeism may stem of health problems on outcomes such as completing from job design and working conditions. Thus, work (e.g. the ability to complete difficult tasks) and well-designed jobs should be avoiding distraction (e.g. feeling the first line of defence against hopeless about completing tasks “Working while unwell working while sick via the careful due to health problems). management of job demands, such A further challenge for may be invisible; not as workload, time pressure and organisations is to set up specific always disclosed by overtime work, and the provision policies to manage presenteeism. employees and difficult to of appropriate support when people Reducing unnecessary absenteeism are absent. Moreover, opportunities without increasing negative detect by even the most to increase job resources such as presenteeism will be difficult sensitive managers and job control that can protect the to achieve – especially in a colleagues. Moreover, at wellbeing of individuals in the culture that expects and rewards long working hours. Given the what point does somebody face of work-related stressors and strains should be maximised. findings of the CIPD survey, it become a presentee?”

As presenteeism is as much would seem appropriate to raise linked to health as absenteeism, awareness among managers organisations could introduce that the long-term risks of workplace wellness and health programmes to reduce presenteeism to productivity are likely to outweigh work-related stress and illness. These programmes any immediate gain. The robust research findings can inspire healthier lifestyle practices, offer health showing that presenteeism can negatively affect the assessments to monitor the wellbeing of staff and wellbeing of colleagues and service users, as well as provide assistance programmes, such as counselling the health and productivity of individuals, should services. By assuring a healthy workforce, these also be disseminated. The recognition that an ‘ideal’ programmes should reduce the costs of absenteeism as employee takes sufficient time off sick to recover, well as presenteeism. rather than struggling to work through illness.

Finally, it should be acknowledged that This would discourage the emergence of an ‘antipresenteeism is not always undesirable and damaging. sickness’ organisational culture that reinforces, or For some chronic disorders, such as depression, even celebrates, working while unwell. Training is attending work while feeling unwell may be a also required to help managers notice the signs and ‘sustainable’ behavioural choice and help people to signals of presenteeism and develop the sensitivity reintegrate themselves back into the workplace. The and empathy needed to support their staff through main challenge for psychologists and human resource illness. Managers should also act as role models for sickness behaviour and take sufficient time to recovery professionals is to understand when presenteeism should be encouraged and when it should be avoided. from periods of sickness. Increasing opportunities A careful assessment of a wide range of factors is for flexible and remote working may also reduce the required when making such decisions, such as the incidence of presenteeism, as people may be able to type of illness, the phase of recovery, the employee’s work from home for part of the day, or during times readiness to return to work, the requirements of the that better accommodate their limitations. job role, the organisation’s willingness to adjust work activities according to the employee’s needs and work capability and the availability of support.

the psychologist august 2017 books

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Adrian Owen At the flimsy border between life and death Jon Sutton meets Adrian Owen to discuss his new book, Into the Grey Zone

What has surprised you most about your journeys into the grey zone?

Working with people in the grey zone – and by that, I mean patients who hover at the border between life and death – I’ve been surprised by many things over the years, but perhaps most obviously that the relationship between what people appear to be and what they actually are is far less clear than we used to think it was. For many years, patients who would not respond to any form of external stimulation, like a request to move a hand or blink an eye, were presumed to be in a so-called vegetative state – ‘awake, but unaware’. When we showed in 2006 that fMRI could be used to reveal covert awareness in some of these

patients, it became immediately apparent what a grave error of judgement that had been.

So what do we now know?

That many of these patients harbour some level of awareness; indeed, some of them are completely conscious, locked inside their own bodies, yet unable to communicate with the outside world in any conventional way. Moving on to start communicating with some of those patients in 2010, again using fMRI, was another major milestone for us. I guess it was less of a ‘surprise’ at that stage, because by then we knew the patients were in there; it was just a matter of developing the technology to the point that we could Paul Mayne

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the psychologist august 2017 interview

open up a reliable channel of communication with them. But it was a thrilling achievement nonetheless.

If I were to get a little more philosophical about what has surprised me most about working in this area, I would have to say that it has convinced me more and more that we really are our brains. As I wrote in Into The Grey Zone [www.intothegrayzone.com], ‘Your brain is who you are. It’s every plan you’ve ever made, every person you’ve fallen in love with, and every regret you’ve ever had. Your brain is all there is. Without a brain, our sense of “self” is reduced to nothing.’

Not all psychologists would agree with that.

I know. Dick Passingham, who is a great friend of mine and someone I have respected for many years, recently pulled me up on this… he pointed out that there is a whole lot more to us than that. As well as our brains, we are our bodies and our past histories, he said. I replied that we can replace almost any part of our bodies and we will remain the exact same person.

But swap out someone’s brain and there is no question that they will cease to be them; their memories, their personality, their attitudes and beliefs, everything will change, including their entire past history (at least as they recall it). The very essence of them as a person will be for ever altered.

Do you have any estimate of how many of these patients might be out there, awaiting that ‘magic’, to be ‘found’?

Improvements in roadside medicine and intensive care have led to more people surviving serious brain damage and ending up alive but with no evidence of preserved awareness. We don’t know exactly how many vegetative-state patients there are, nor how many of them are trapped in ‘the grey zone’, awake and aware, but unable to convey that fact to the outside world.

This is due, in large part, to poor or non-centralised nursing-home records. In the United States, estimates range from 15,000 to 40,000 vegetative state patients.

Given that number, our findings suggest that as many as 7000 of these patients might actually be aware of everything going on around them. Such patients can be found in virtually every city and town in the world with a skilled-nursing facility.

A while back I sent you my own draft ‘Advance Decision’ [available via our website], and while saying you do advocate them you cautioned ‘Imagine again that you are aware and have to witness your own death just because you used to think that was a good idea’. How do you deal with that conundrum?

Great question! The reason I said that back then was because I was beginning to realise that what most of us think we would want if we are unfortunate enough to end up in the grey zone, is not actually what we want when we get there. How many times have you heard (or said) ‘I don’t want to end up like that – pull the plug!’ Through technology like fMRI we have been

able to communicate with some of these patients and we now know that their lives are not necessarily as bleak as we might think they are. That’s not to say that they are blissfully happy, but consider this example; my colleague Steve Laureys recently surveyed 91 people with locked-in syndrome—conscious people who were only able to communicate by blinking or vertically moving their eyes. They were asked to answer a questionnaire about their medical history, current status, and attitude to end-of-life issues. Contrary to what most of us might expect, a significant proportion of the patients (72 per cent of those who responded) reported that they were happy. What’s more, a longer time in a locked-in syndrome was correlated with how happy this group said they were.

Not everyone has been convinced by your work, pointing to physiological and statistical artefacts and cautioning against over-interpretation. How do you respond?

This is a great question that gives me an opportunity to point out that I don’t get to spend my whole life just doing cool science! In fact, I spend a lot of time managing people’s expectations, juggling the demands and interests of doctors, patients and families and justifying the scientific conclusions we have reached to people who may not believe, or understand, what we have discovered. For me, this is the ‘politics of science’, and it’s a necessary evil. We can’t just sit in our ivory towers discovering stuff, writing about it in scientific journals and hoping that everyone will just take it at face value. I’ve generally found that it’s very worthwhile taking the time to explain our findings, sometimes even running additional experiments to rule out artefacts or potential design flaws and usually the end result is a better understanding of the data and a more accurate interpretation of the results.

In many instances, it’s been the criticisms that have driven me on towards the next big question.

For example, I remember after the 2006 paper came out in Science a small, but vocal, contingent doubted our findings; they said that fMRI activity alone was not sufficient to conclude that our patient was conscious. This scepticism led directly to our next step – to actually communicate with a patient who was presumed to be vegetative. My reasoning at the time was ‘if they don’t believe the patient is conscious, what better way than to get the patient to tell us themselves!’

But that said, overall, I have had tremendous support from both the scientific community and the public for my work, and I am very grateful for that.

Very few psychologists – sorry, ‘neuroscientists’! – can claim to have pioneered a new field of science.

Do you put this down to vision, luck, a bit of both?

I would never claim to have pioneered a new field of science – apart from anything else, I have worked with amazing students, postdocs and collaborators for many years and they have all contributed in great and small ways to the emergence of this field. In many

ways, my role has been to bring these people together – often from disciplines that might never normally talk to each other, like engineers, ethicists, psychologists and critical care staff. That’s when the magic really happens!

But I have also been very lucky; I trained in psychology in the late 1980s and that really equipped me well for the emergence of cognitive neuroscience and brain imaging. When PET and then fMRI came along in the early 1990s, I think I was really well positioned to get into those fields using sound psychological principles. In those early days that was really important, because there was a lot of really terrible brain imaging being done in the name of psychology! Then, having that solid grounding in brain imaging, allowed me to look beyond simply ‘brain mapping’, which is what I did for most of the 1990s, and find a real application for the technology in a clinical setting. I wouldn’t say I ever had a ‘vision’ for any of this, but perhaps it helped to have a sense of knowing what I knew, and the foresight to try to apply that knowledge to novel situations and scientific questions.

So you’re a psychologist – one of the last (as in, youngest) of the ‘old guard’ of British psychologists, the UCL/APU school. Familiar figures crop up in the book, such as John Duncan, Pat Rabbitt, Trevor Robbins. Can you understand us having a little pang of jealousy at seeing ‘A neuroscientist explores…’ on the cover?

I am very proud to have trained in psychology, and I think it provided me with many of the tools that I have used over the years to tackle the scientific questions that have interested me, from how to design a rigorous experiment to an appreciation of medical ethics. But there came a time when describing myself as a ‘psychologist’ no longer told people much about what I actually do. In fact, it often gave them the wrong impression entirely. One of the themes running through Into The Grey Zone is how the field that we now know as ‘cognitive neuroscience’ emerged out of psychology with a lot of help from brain imaging, and my career followed that very same path across the same time span. I am a psychologist at heart, but a lot of what I do is better described as neuroscience.

I like to think that what I am best at is applying good psychological principles to neuroscientific questions, some of which may not seem very ‘psychological’ at all.

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You and your teams have had so many successes. But, like neurosurgeon Henry Marsh in Do No Harm, you seem somewhat inevitably haunted by the failures.

Peering into your past girlfriend Maureen’s brain, only to see ‘darkness. Quiescence. A void’, or being bold enough to ask John ‘Do you want to die?’ and getting inconclusive results.

I don’t think I am haunted by the failures, but ups and downs are the reality of science, particularly when you are pursuing a single, burning question over many

Dr Adrian Owen is the Canada Excellence Research Chair in Cognitive Neuroscience and Imaging at The Brain and Mind Institute, Western University, Canada. Into the Grey Zone: A Neuroscientist Explores the Border Between Life and Death is published by Guardian Faber (£16.99) www.intothegreyzone.com A review and extract will appear on our website ahead of the book’s UK publication in September

years. The problem is, in the scientific papers, readers often only get to see the highlights… the net result of several experiments and the summary of what we think it all means. I’m not talking about the tendency not to publish negative results – that’s a different type of problem – but rather, all the ideas that never got off the ground, all the unfortunate twists and turns that got in the way of the science. In our case, patients dying (or recovering) just as we’re about to make contact with them is a fairy common occurrence. Of course, our first thoughts are with the families, but I can’t pretend that these things aren’t also scientifically disappointing because often it sends us right back to the drawing board.

Writing the book gave me the space and the freedom to write about these things and express how they make us, as scientists, feel. Of course, the science is in there in a way that I hope everyone will be able to understand, but there’s also a lot about the process of doing science, the ups and the downs, the triumphs and the failures, the setback backs and the

the psychologist august 2017 interview

sense of sheer exhilaration that I still get when we do occasionally make a break-through. What I really wanted to convey in Into The Grey Zone is what it’s actually like to be a scientist, set against a backdrop of the scientific discoveries themselves and, of course, the incredible stories of the patients and their families.

That really does come across in the book, which is beautifully written. Where did that come from?…

Did you find it easy? Did it surprise you?

I resisted requests to write Into The Grey Zone for many years, because I wasn’t really sure that I could do justice to the patients and their extraordinary stories.

I have written hundreds of scientific papers, but this required a different kind of approach. Fortunately, our research has received plenty of attention from the media and the public over the years, and this has given me a reasonably good sense of how to write for (and talk to) the non-expert, and that made it much easier than I expected.

One side note that might be of interest to your readers; I began writing these stories against a backdrop of the relevant neuroscience, focusing on the anatomy of the brain, the function of various regions, and so on, but quite quickly realised that wasn’t where my heart was and that wasn’t going to be a very easy book to write. About two chapters in, I realised that it was the psychological aspects of the scientific journey that fascinated me most, why we think the way we think and why that is such a critical and vulnerable part of the human condition. Once I’d found that voice, it became much easier to keep writing.

You dedicate the book to your son, saying ‘In case I’m not here to tell you the story myself’. That struck me as a little fatalistic! Then I realised you had returned to that point in the acknowledgements…

I’m glad you noticed that. It was always my intention to dedicate the book to my son Jackson because it was written during the first three years of his life, in between (and sometimes during!) nappy changes, midnight feedings and many, many sleepless nights.

The story also covers a period of my life that in many way defines who I am now as a person. When I read a book dedication, I always feel a bit short-changed when there’s no explanation. ‘For Jackson’ doesn’t tell you anything and why this book is for Jackson.

I added ‘In case I’m not here to tell you the story myself’ because I hope that one day he’ll read it and understand something about my life that won’t be obvious from the daily interactions he and I share as father and son. I hope I’ll still be around to add additional colour, of course, but something I have learned from working in this area is that there is absolutely no way to predict that. As I wrote at the end of the book, ‘working at the flimsy border between life and death, the sheer fragility of every human life is hard to ignore’.

Have you found a growing need for some ‘light relief’

in other areas of your personal and professional life?

I have never been a terribly serious person and I have always pursued things that interest and entertain me.

But it’s tough to try to fit it all in. One way is to just combine the two. I play guitar and sing in a band called Untidy Naked Dilemma (https://youtu.be/ b7oShriLYVA), made up entirely of neuroscientists and that’s been an incredibly important part of my life for many years. In various forms, the bands I’ve played in have performed all over the world, often at academic conferences that many of the members of the band were attending.

From time to time, I’ll also do a fun scientific study with someone who is an academic friend rather than a regular collaborator, just because we can and because it’s fun. Richard Wiseman and I, who have been close friends for more than 30 years now – we were psychology undergraduates together at UCL between 1985 and 1988 – recently published a study together pointing out that about 80 per cent of the time, pictures of the human brain are presented facing to their right (that is, we mostly get to see the left hemisphere). Why that is we do not know, but it’s one of those quirky little things that Richard spotted and we decided to write an academic paper about it. It’s wonderful to have the freedom to do things like that with your friends, especially after 30 years in the field.

In any area like this, dark humour can be a defence mechanism, and there’s a bit of that in the book. The locked-in patient subjected to one Celine Dion album springs to mind. What would be your own torture track – something by your own band maybe?

If I were ever unfortunate enough to find myself in the grey zone then I am fairly sure that my students would put me straight into the fMRI scanner and ask me to ‘imagine playing tennis’. Although it might well help them work out whether I’m in there or not, after all this time saying those words, I’m not really sure I ever want to hear them said to me!

There is quite a bit of humour in the book, and that was always intentional. Despite some of the awful things we have to witness on a day-to-day basis, funny things do happen, and I included them in the story because that’s the reality of the situation and I wanted to remain as honest as I could to that reality. I can imagine that people might think it’s terribly depressing working closely with people at the border between life and death, but there are plenty of funny moments, surprising moments, joyous moments and exhilarating moments, and I really wanted that to come through in the pages of the book. When you’re working with people who are living with terrible life circumstances it’s important to keep some perspective, or it really would be very hard to go home and sleep at night.

Oh, and it would have to be the ‘The Final Countdown’ by Europe, mostly because it haunted my undergraduate years at UCL (it was #1 in the UK charts in 1986), but also because the cruel irony would be simply too much to live with…

Repent and reform Mark Andrews (Nottingham Trent University) reviews The Seven Deadly Sins of Psychology by Chris Chambers

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or the past few years, the discipline of psychology has been undergoing a period of methodological self-criticism and debate that we usually refer to as the ‘replication crisis’. It began in 2011 and went up a gear in 2015 with the publication of the results of the Reproducibility Project that were widely interpreted as showing that perhaps only one in every three psychology discoveries are in fact reliable. Professor Chris Chambers offers the first major book to emerge from this debate.

His premise is that psychology is indeed in a perilous position, and may soon fall by the wayside in the onward march of science generally, eventually becoming little more than a cautionary tale of yet another protoscience

that never made it to maturity. The book aims to uncover the root causes of this worrying state of affairs and, as the title implies, identifies seven major contributing factors (or ‘sins’). These are: publication biases that demands novel and positive results; the gaming of statistical tests to always achieve statistical significance; our use of low-powered studies and our aversion to replication studies; our ‘dog in the manger’ attitude to our own empirical data; the problem of outright fraud; closedaccess publishing; and our obsession with proxy metrics to quantify quality. As a consequence of this collection of problems, the discipline of psychology has become a system for the mass production of false discoveries:

the psychologist august 2017 books scientific dross is packaged and sold as scientific gold, and we’ve deprived ourselves of our much celebrated self-correcting mechanism to eventually root out and discard these mistakes.

What I valued most about this book is its thoroughness and the seriousness of its tone. It would be easy to cheapen or sensationalise this topic. After all, the replication crisis has become a popular subject of debate within psychology. It has even permeated into mainstream media where it has sometimes been unfortunately sensationalised (recall, for example, the Independent’s August 2015 headline about the reproducibility project: ‘Study reveals that a lot of psychology research really is just “psychobabble”’). Moreover, the debate often plays out in the rough-and-tumble world of social media where the discussion has sometimes become unedifying, to put it mildly. In Chambers’s book, the discussion is always detailed and careful. All arguments are backed up by ample evidence. Indeed the book’s extensive endnotes are a trove of relevant facts and references, and in themselves serve as an annotated bibliography of the entire replication crisis. There is no attempt to scapegoat and vilify any particular individuals or subfield or method (for example, the humble p-value is not treated as a whipping boy, as has sometimes happened in the past, but is treated fairly in the context of more general discussion of statistical testing). Even if one did not fully agree with Chambers’s diagnosis or prognosis, I don’t think anyone could see this book as anything less than a detailed, careful and reasonable analysis of the current state of psychology.

Ultimately, this is not simply a description of a problem, but a call for collective responsibility and action. Its general perspective is that we’ve collectively created this problematic culture and we should own up to this and then take the necessary steps to reform the field. Those steps to reform are sometimes obvious and could be implemented immediately by any of us (for example, what is stopping any of us from conducting high-powered studies, publicly preregistering our hypotheses and methods, sharing all our empirical data and materials, and so on?), and so all that is required is just a change in our culture and values. Of course, culture can be surprisingly intractable. The dominant tendency of any group or organisation is always in favour of maintaining the status quo. What matters for the future of psychology is how well the advocates of reform can convince the majority to overcome their natural aversion to change.

In this respect, this is an important book and one that I hope is widely read and discussed. It marshals all the arguments concerning the inadequacies for our current scientific practices and provides detailed examples of the many options we have for reform, and it does so in a generally positive and constructive manner, without ever being divisive and pugnacious.

Useful and practical advice

Read our extract thepsychologist.bps.org.uk/ vaccine-against-bias

Reviewed by James Hartley, who is Emeritus Professor of Psychology, Keele University

This range of invaluable updates will benefit readers at different stages of their development as psychologists.

The text has always offered psychology students and researchers helpful resources with writing and scientific communication, but the new edition has a broader focus to reflect the increasing media through which modern psychology students and professionals communicate.

Split into four parts, the text distils the experienced authors’ helpful advice on planning, writing and publishing psychological articles, before reflecting on other ways in which a psychologist might present themselves, including new content such as poster presentations, job interviews and in the media.

The authors have added explicit prompts for readers to reflect on topics as well as providing insightful examples from their own careers that keep the reader engaged. The updated guidelines for using the sixth edition of the Publication Manual of the American Psychological Association will no doubt be used extensively by students and academics alike given the clarity with which they are presented.

The newest edition of The Psychologist’s Companion is an engaging, accessible and helpful text filled with useful and practical advice

The Psychologist’s Companion: A Guide to Professional Success for Students, Teachers, and Researchers (6th edn) Robert J. Sternberg & Karin Sternberg Cambridge University Press; Pb £29.99

for psychologists at all stages of their career. The authors have created a text that will no doubt continue to be an essential resource for students and early-career psychologists amongst others.

Reviewed by Bryan McCann, who is a Lecturer in Sport and Exercise Science

Shed some verbal flab Is your text – er – a bit flabby? This short text uses the language of dieting to suggest how writers can improve their writing. Readers can skim or skip the explanatory text and use a computer-based program to analyse their writing (www.writersdiet.com). You enter your text and it’s scored on five subscales (heart attack; flabby; needs toning; lean; and fit and trim) for each of five measures (verbs, nouns, prepositions, adjectives/adverbs, the use of it, is, that and there).

I used this program when writing the above (and I am not reporting on how many changes it suggested to my initial draft). Like all such tools, it is based more on experience and intuition than detailed quantification and research. It is a bit of fun, costs nothing, and will improve your writing.

The Writer’s Diet Helen Sword University of Chicago Press Pb £13.90

A book that shaped me On Twitter, we asked our followers to share ‘a book that shaped me’. First up, Dr Alison Rodriguez (a lecturer in Child and Family Health at the University of Leeds) expands on her choice, and then we present a selection of others.

Armfuls of Time Barbara Sourkes This book has been of great influence on me and my postgraduate career. The focus is the psychological experience of the child with life-threatening illness, through the lens of psychotherapeutic practice. The book is full of practice excerpts, detailing perceptions often linked to time and entwined with the tenets of spirituality.

Indeed, these children are reported to manage multiple losses, as they navigate through their illness trajectories.

life-threatening/limiting illness. My work since has been collaborative, following on from Sourkes’s advice to form alliances with children and parents. Drawing on techniques of creative research engagement (not too dissimilar to those therapeutic styles of inspiration reported

by Sourkes) and storying experiences, helps us to identify how we can support children, young people and families more widely and across practice boundaries.

Starting out as a health psychology postgraduate, my academic journey has gone from reading Sourkes’s book and allied literature, working in a psychology department, teaching generalist and core subjects, to working in a school of healthcare and being situated in a child nursing team. I conduct child and family health and wellbeing research, and share my related perceptions and psychological viewpoints with the next generations of child-focused health and social care practitioners.

Andrew Perry @coproductiveEqu Introduction to object relations by Lavinia Gomez

Sarah Ann Walker @SarahAWalker The Little Prince is a gorgeous book that shaped my thoughts about human connection & the importance of thought, discovery & living.

Tara @x_TaraS_x Resurrection after Rape (Matt Atkinson)… completely turned my life around from self-destruct to where I am now.

Craig Harper @CraigHarper19 The Righteous Mind by @JonHaidt.

Incredible exposition of deep psychological reasons for increasing political differences.

There are key messages alluding to bearing witness to the child’s experience and to trying as best as one can to understand the child’s gaze. The last chapter of the book deals with death awareness and has stayed with me – children and young people are often left working it out for themselves.

Descriptions of existential distress and child withdrawal are hard-hitting. How can we make things better? The text throws up so many practical, theoretical and phenomenological questions for me.

As a slightly younger academic, unsure of what direction to take my PhD studies in, this book assisted my focus. Little is said or explored, even to date, in the peerreviewed literature with respect to the child or young person’s perspective of 60

Austen Psychology @DrSallyAusten Jennings – I still cry with laughter Ginny Evans @ginnyevans44 Anything by Roald Dahl. I’m now introducing them to my kids. They gave me pure joy and fun and gobblefunk!

Scott Gladstone @ScottStudies An Unquiet Mind, Jamison; The Examined Life, Grosz; The Road Less Traveled, Peck Fraser Smith @FSmithCPsy Mans search for meaning. The alchemist.

Nihan Su Albayrak @nihanalb The Tartar Steppe by Dino Buzzati.

Dr Liza Morton @DrLizaMorton The Man Who Mistook his Wife for a Hat.

Nicola Kippax @Niccolakippax Fine balance by Rohinton Mistry Jo Varela @dr_jovarela Herb Lovett. Learning to listen.

Michelle Jamieson @themichjam Even though relatively recent it was @chinatmills Decolonizing Global Mental Health.

Eilidh Albert-Recht @EilidhRecht One Flew Over the Cuckoo’s Nest – Ken Kesey. Destroyed my copy thumbing through it… set me on a psychology path.

Gary Jones @Zerothehero87 The Demon Haunted World by Carl Sagan, Lying by Sam Harris and The Believing Brain by Michael Shermer are three!

Next month: Psychology undergraduates on the books they would recommend to new students.

Excessively Me @ExcessivelyMe25 I read The Bell Jar in college and for the first time I felt like I could be understood and talk about my #mentalillness.

Graham Davey @GrahamCLDavey Skinner’s Beyond Freedom & Dignity – I got the only copy from the local book shop at the time… the rest of the lab have never forgiven me!

If you have an unquenchable thirst for summer reading, see also thepsychologist. bps.org.uk/your-summer-reading for our recent book extracts, and thepsychologist. bps.org.uk/ultimate-psychology-readinglist for 100+ recommendations from our ‘One on One’ interviews.

Share your own influential book on #BookThatShapedMe or by emailing the editor on jon.sutton@bps.org.uk

the psychologist august 2017 books

Not convinced Grief: How It Harms and How to Cure It claims to offer ‘a revolutionary single session approach to achieve a complete release from the suffering from any form of grief of any origin and duration and to regain normality for the rest of life’.

Dr Aravind talks about the rationale behind developing the approach – the Question and Answer model; existing theories and approaches for addressing grief do not tend to remove the adverse effects of grief entirely and/or permanently. Harmless and harmful grief are described, with the latter including aspects such as guilt, anger and shame, and typically requiring intervention. The majority of people who are grieving, whether arising from death of a loved one or a relationship break-up for example, will tend to ask questions.

Different stages involved in working

The case studies provided are useful in demonstrating the application of the model and its effectiveness. It could have been beneficial to have more discussion on issues encountered in applying the model and ideas into practice, and how to deal with such issues. The book could be perceived as repetitive in places, and based on personal and professional experience to date I remain unsure as to whether it is feasible to reduce or eradicate an individual’s harmful grief within one session. Regardless of this, the importance of communication and rapport are emphasised, and valid points are discussed in relation to a very much-needed topic of research. therapeutically with grief are discussed, such as building rapport, introducing the individual to the concept of harmful grief, and helping the individual to say goodbye.

Reviewed by Charlotte Hague, who is a counselling psychologist with Worcestershire Health and Care NHS Trust

Where do you see yourself…?

The Psychology of Job Interviews Nicolas Roulin Routledge; Pb £19.99

There are umpteen guides to job interviews out on the web, including guidance for candidates (e.g. how to prepare, what to say and not to say) and for employers (e.g. what questions to ask, and what to avoid). But none of these are backed up by research and evidence;, somewhat concerning as the traditional ‘triad’ of CV/application form, interview and references is still the selection method of choice.

Roulin’s slim book (six chapters, 166 pages) hence fills a clear gap guiding the reader through the interview process. Starting with the basic principles of what an interview is, it then considers the sides of the interviewer and interviewee to guide best practice. It covers process issues in terms of how best to prepare for interviews and how to make candidates comfortable, but also the structure (what questions to ask and in what order) and on what basis to formulate decisions (which candidate will you select?).

The chapters also do not shy away from some more controversial topics, such as the inherent bias and subjectivity of interviews and how to manage this, or how to conduct panel interviews. These latter are very common in my world (academia), yet there is precious little guidance out there on how to manage them.

HR practitioners and managers, as well as job seekers, will have a lot to gain from reading this book, as it offers a solid overview referring to relevant research throughout. My only slight gripe is that some checklists, or guidance tips would have made the book even more accessible; maybe that’s a development point for a second edition.

Reviewed by Almuth McDowall, Assistant Dean, Department of Organizational Psychology, Birkbeck University of London

Grief – How It Harms and How to Cure It: The Question and Answer Model Kottiyattil K. Aravind CreateSpace; Pb £7.99

‘Psychologists should stop selling themselves short’ Hamira Riaz’s talk to the BPS London and Home Counties Branch in April – ‘Breaking down the silos: What can occupational psychology learn from clinical psychology (and vice versa)’ – reflected a theme in many recent careers interviews. Ian Florance met her.

Dr Hamira Riaz’s experience in clinical neuropsychology and business psychology (within the NHS and Ministry of Defence, then at a global consultancy, and now in independent practice) helped form her opinions on psychology as a divided profession. She’s authored articles on a dizzying variety of subjects and she identifies herself as an agent provocateur. ‘The price you pay as a generalist rather than a super-specialist is that you’re never truly part of a tribe. But you get the pleasure of sitting outside and throwing stones over the walls to remind people you are there.’

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‘We are there to serve people, not to treat them as data points’ ‘I was taught to believe that psychology’s role is to guide people from dark places into light; to help them join up the dots of their lives in fresh, constructive ways. We make our core purpose harder by being a divided profession. Of course, there are distinctive elements in all psychology specialisms but there’s common ground too; we are agents of change, striving for excellence, fixing what’s broken and starting from the personal perspective. Being able to move between and across different areas offers nothing but opportunities: we have so much to learn from each other. The future is interdisciplinary… but having worked in both clinical and occupational psychology contexts, I would say that, wouldn’t I!’ In expanding on this theme, Hamira uses clinical practice as an example. ‘I qualified in 1996. I was part of the first-year intake for the Doctorate in Clinical Psychology at Leeds. It was very special to be part of that cohort: like being Kings and Queens of the therapy world! The course was multi-modal and eclectic, demanding big and broad thinking. The rise and dominance of formulaic approaches like CBT has meant clinical psychology practice has become increasingly reductionist. In the process, it has lost key aspects of its unique selling proposition, something clinical psychology must re-define if it isn’t to become lost in an increasingly mono-therapy landscape.’

the psychologist august 2017 careers

and Dad were married by proxy and met for the first Hamira argues that instead of challenging time at Heathrow Airport. One of my first memories – prevailing cultural paradigms, psychology has gone I was three – is a family car journey from Manchester along for the ride, most notably in its longstanding to Karachi. The 1971 India/Pakistan war broke out obsession with being seen as hard science. ‘I wonder while we were there, and I have flashbacks of bombs what has fuelled this decades-long push toward falling in the Karachi night sky whenever I smell treating people as confounding factors in carefully aviation fuel.’ controlled experiments. Does it reveal a fundamental Hamira’s father wanted her to become a doctor discomfort with the messy business of dealing with actual human beings? The current focus on publication before she got married (‘My mum thought I was too independent and was appalled at the prospect of bias, decline effects, voodoo correlations and the leaving it so long’), and she had a place at Manchester replication crisis, et cetera., is well overdue! I hope Medical School. But human behaviour interested her the profession can move away from a predilection more than medicine, mainly because ‘people always for slicing and dicing human behaviour so that it seemed to feel comfortable confiding in me. I was is no longer relevant to peoples’ real lives. I think thinking about psychiatry as an option, but when I psychological practice is at its richest, not to mention didn’t get the B grade in Physics that I needed, I took most honest, when characterised by theoretical diversity, clinical dexterity and a willingness to own up the offer of a place on the psychology course at Leeds University. It was a way of killing two birds with one to everything we don’t know about the human psyche.’ stone; to move away from home and to get out of As an example, Hamira suggests the space studying medicine.’ opening up around wellbeing and the so-called Hamira identifies another more major influence ‘worried well’. ‘Providing timely help to distressed on her life. During her teenage people, thus preventing problems years, two of her younger brothers from despoiling their lives, “I wonder what has fuelled were diagnosed with a very rare must be a golden opportunity genetic condition, Friedreich’s for a united psychology; it’s this decades-long push ataxia – ‘think of it as a sort of where clinical psychologists toward treating people long, drawn-out version of motor working in partnership with as confounding factors neurone disease. There was no occupational, educational and test to determine whether I was a coaching psychologists belong. in carefully controlled carrier. Though it wasn’t done in an Yet, this area has been colonised experiments” obvious way, slowly we all became by homeopathy, life coaches and pariahs in the community, and new age practitioners. I’d like to see naturally my currency as a potential psychologists shift from searching bride fell sharply. That drew us together. Our attitude for silver bullets within their silos, and become more was “To hell with you, we’re fine as a family unit”. courageous and creative in how they think across I think I shut down emotionally over that period mental health and work-related boundaries.’ though and it cemented my sense of being “the other”, Not that Hamira welcomes all cross-fertilisation the perpetual outsider.’ uncritically. ‘There’s a new fad every year in business Graduating in 1988, during a recession, Hamira psychology. Most recent ones have been prompted by says that in common with many psychology graduates developments in cognitive neuroscience. One of the she didn’t know what to do next. ‘I applied to the likes reasons I was drawn to clinical neuropsychology was of Mars, Accenture and the Civil Service, but I was the joy of working in multidisciplinary teams with drawn to the idea of a clinical career. The problem neurology, neuroradiology, neurosurgery, et cetera. was – and still is for many students – that it’s a long, During those years, I began to understand the limits hard road. I was going to find it very difficult to of our knowledge about the relationship between sell the idea to my parents because by this time, my the structure and function of the brain. The most mum was desperate to get me off her hands. Luckily, disturbing trend in the past decade has been leaps of I was presented with a get out of jail card. I applied inference about complex social behaviour based on for an ESRC scholarship to do a PhD at the Institute pretty MRI brain scans. Clinical neuropsychologists working closely with occupational psychologists would of Psychiatry. I built my application around Peter Stratton’s Leeds Attribution Coding System – it had be a dream team in this space, not only to explain a lot to do with me getting the grant and for that I’ll what we can and cannot extrapolate from scanning always be grateful. I moved to London for three years. technologies, but to stop the nonsense being fed to the The problem was, at the end of it, I still didn’t know public about brain–behaviour relationships.’ whether I’d take a clinical or occupational route. Then my father died and I became the main provider for the family. Clinical was the safer career choice.’

‘I’m better at starting things’ Hamira claims luck and opportunity shape her I asked Hamira to describe her background and where experiences, though it’s clear that a huge variety these passionate views come from. ‘I am a born and of interests also defines her choices. This ‘protean’ raised Northerner and a first-generation citizen. Mum

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done by clinical psychologists employed by the NHS, approach to career progression might underlie her but the fee structures are vastly different. That can’t suspicion of silos. ‘Neuropsychology was still seen be right and I’m all for the idea of a Royal College for as a little exotic back then. Yorkshire didn’t have a Clinical Psychology if it can redress the balance.’ regional neurosciences setup, so I looked at doing my final-year placement at the Walton Centre in Liverpool. Gus Baker and Eric Ghadiali, who ran the ‘Psychologists are special!’

Neuropsychology Department there, were the most Hamira was one of several directors who left YSC glamorous psychologists I had met – it was then that in 2013 to set up her own practice. ‘Since then I’ve I knew I had found “my people”. Much later, working combined clinical work with corporate consultancy in neurosciences proved invaluable in getting access and executive coaching. I follow my interests in to the expertise and support networks we needed as a areas as diverse as unconscious bias, women in the family when my brothers’ condition worsened.’ workplace, the crisis of masculinity and the role of Hamira’s first job post-qualification was at mid-life crises. I’m finally at liberty to use an arsenal Hope Hospital in Manchester, which had just been designated the neuroscience hub for the region, a ‘once of techniques that transcends the Society’s Division structure. And I’ve also faced up to my fear of public in a generation opportunity’. She commissioned and speaking. For years, I’ve watched people talking set up regional neuropsychology services, specifically and writing about psychology and thought, “I could for neurological conditions. She recalls working flat do that”. As you can tell, I have out for three years whilst also strong opinions about just about completing a PGDip Clinical Neuropsychology. ‘I got close to “‘Dig deep to understand everything. But I used to keep a lot to myself, expressing opinions burnout. I had set my heart on why psychology excites brings the risk of being judged. getting to consultant grade and you, then decide However, such reticence born of I was very proud of the work fear is the ultimate betrayal of one’s we’d done, but I started feeling which area you want ability to affect change. Besides, I’ll that it wasn’t enough. Then, a to start with” be 50 this year, and maybe I just job appeared at the Psychological don’t care what people think as Corporation, the publishers of the much as I did.’

Wechsler IQ tests. By the time I A couple of years ago, Hamira joined the British moved back to a consultant grade job in Manchester Psychological Society’s media panel, started writing 15 months later, the NHS just didn’t fit me any more. a regular column for a compassionate business I’m at my best when starting with a blank page and magazine, and she’s the resident psychologist for a TV building something ambitious from nothing.’ show about generational differences which aired in That’s why the next job as Head of May. She’s also a mentor on the Clinical Psychology Neuropsychology at the Ministry of Defence ticked Future Leaders Programme (CPFL): ‘It’s a great all the boxes, on paper at least. ‘I had the honorary initiative supporting clinical psychologists in a way I equivalent rank of Lieutenant Colonel: I won’t pretend wish had been around when I was in the NHS.’ I didn’t enjoy being saluted and being called ma’am! I I asked Hamira what she’d say to someone also know that as a woman of colour, I got the diversity vote. But the MoD quickly taught me anything I hadn’t considering psychology as a career. ‘Dig deep to understand why psychology excites you, then decide already learnt about the power of patriarchy, the perils which area you want to start with… and how you can of in-house politics, the cost of personality clashes and best express your core purpose through that. Don’t systemic resistance to change.’ let anyone tell you that you can’t change your mind Leaving without a job to go to, Hamira trekked later. You can! Have the courage to stand out. Learn to around India for three months. ‘I spent my savings say “no” if the system you’re part of no longer serves and shrugged off my clinician identity so that when you. Your perspective as a psychologist, whether that I came back I started a journey with YSC, a business be clinical or occupational, is unique and eminently consultancy, which was just then expanding its global transferable to other areas of psychology. Psychologists footprint and recruiting clinical psychologists. I are special! If you don’t believe that, don’t do it!’ moved to Australia and spent most of the next year And one thought for practising psychologists? working across Asia-Pacific. Despite feedback that it ‘I’d ask them to stop selling themselves short. Human would take time for me to understand the commercial beings have always been fascinated with themselves context of the work it really didn’t, but I did learn and with each other. The public will never get enough some important lessons: building my personal brand; of psychology. There’s magic in human behaviour and selling psychology to clients and that you’re only as there’s an artistry to understanding it. The practice of good as the project you’ve just finished.’ Here Hamira psychology is as much alchemy as it is a science. It’s emphasised a point strongly. ‘The work done by inherently mysterious, and because as a profession we occupational psychologists is worth no more than that aren’t comfortable with that, we leave people at the mercy of stage hogs and charlatans.’

the psychologist august 2017 careers

NOTTINGHAM 2018

The British Psychological Society’s Annual Conference East Midlands Conference Centre, Nottingham 2–4 May Confirmed Keynotes Professor John Antonakis, University of Lausanne Professor Brian Nosek, Centre for Open Science Professor Cathy Creswell, University of Reading Stephen Reicher, University of St Andrews Visit our website now to register your interest for exciting conference updates.

Follow us @BPSConferences using #bpsconf.

Credit: John Wright, johnwrightart.blogspot.co.uk

www.bps.org.uk/ac2018

Keeping the memory alive Ilyana Kuhling is the winner of our annual poetry competition

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ur annual poetry competition has been won by Ilyana Kuhling, a psychology student at the University of Limerick. The competition judge David Sutton, a published poet and our editor’s Dad, felt that Ilyana’s poem was ‘spare, controlled and poignant’. He added: ‘I suspect the title is a nod to Walt Whitman: “I am large, I contain multitudes”, though Whitman was speaking in the context of self-contradiction rather than the changes wrought on us by time.’

Ilyana tells us she started writing after joining a creative writing poetry group in secondary school.

‘I’m now in the final year of my undergraduate, and throughout my studies I’ve been involved in local poetry groups in Limerick. In particular, a local group called Stanzas helped me get my start. I also spent a year abroad in Toronto where I was involved in the Art-Bar poetry society, which has been active in the city for over 20 years.’ Ilyana’s favourite poets include Sylvia Plath and

Elizabeth Bishop, and she firmly believes that a good cup of tea can solve almost anything.

‘Multitudes’ is one of a series of poems titled ‘Ambiguous Loss’, written about Ilyana’s grandmother, who is in the final stages of Alzheimer’s disease.

‘Ambiguous loss is a term I came across that refers to an unresolved loss, or loss without closure. It can be used to describe the complicated grieving process that family members of individuals in a state of cognitive decline, due to Alzheimer’s disease or dementia, can experience.

I found the term captured my experience so well; for a while, there were days when she was present, and others when there was no glimmer of recognition. In the last year, unfortunately, her situation has worsened and her only presence is physical. “Multitudes”, then, is my attempt to deal with this, and “piece her back together”, in a way, by cherishing the best memories that I have of her while acknowledging that she will soon pass on.’

the psychologist august 2017 culture

Pop gifted

Ilyana says that writing about her grandmother has helped her to come to terms with the illness. ‘She was a poet herself, so in a way, I hope that my own poetry keeps her memory and her passion for writing alive.’

Ilyana wins a £50 book voucher courtesy of BPS Blackwell. Search our website for winners from previous years.

MULTITUDES I am looking at you now, piece by piece To reconstruct the you you were I strip away The hair, white wisps The skin, paper-thin, translucent The muscle, the fat, the soft Right down to the bone your bones containing multitudes Of a lifetime and my father’s and mine I piece you back together Carve the muscles that would hold me tight in your arms The fat that made your embrace so warm The skin, toughened with time The hair as thick as mine I am looking at you now and you are looking at me too.

Somewhere in those eyes of deepest blue I think you recognize me, And I, you

When a seven-year-old suddenly demonstrates her ability with differential calculus, you might wonder where she got it from.

According to the film Gifted, in little Mary’s brain the postgraduate mathematical techniques, including perfect knowledge of Greek symbols, just popped up magically. This small child corrects the finest work of the Professor of Maths with equations covering three closely chalked blackboards. He looks suitably humiliated. But she thinks nothing of it. What’s more, from her media-free, mosquito-ridden one-room home in Florida, she is able to discourse on the current position of the euro and esoteric history, and is morally superior.

Being gifted, whether in terms of high-level potential or precocity, is an aspect of child development.

Yet it is particularly susceptible to the stereotyping assumed in this film. Gifted Mary, played by McKenna Grace, is delightful. Frank, her uncle It goes to court. Turns out that and carer, played by Chris Evans, Mary’s mother was also a maths wants her to be normal, that is to whizz who committed suicide and avoid the common expectation of the her grandmother is an gifted child as unhappy affectless Cambridge and friendless, for which film maths graduate. there is no scientific Gifted English Evelyn employs evidence. Indeed, my 35Marc Webb (Director) sweeping statements like, year study using double ‘Extraordinary people control groups, published come with singular issues in Educational and Child and needs’. Frank (recently Captain Psychology in 2013, found that America) wants to ‘give her a life’ and although the gifted did face special shoots back, ‘If Einstein can ride a challenges, the reasons for any emotional distress were usually more bike so can she.’

The judge is faced with the commonplace (Freeman, 2013). decision of Solomon, whether The dramatic tension in Gifted to encourage or restrict Mary’s is between Mary’s development intellectual growth. She faces as weird if she is permitted to flex fostering. Frank muscles in and her implausible abilities, versus a rescues the sobbing child. Beach and happy little soul if she denies them. sunset. The folksy music swells. The Mary, although decidedly mature ending is compromise and she gets (actually 11 in real life), has no to join the girl scouts. To have even a say in whether to repress her gifts little credibility any story needs some every day in her normal school or ring of truth, which unfortunately is tackle a higher level of education in not present in this film. a school for the gifted. Her uptight English grandmother, Evelyn, played Reviewed by Joan Freeman, who has

by Lindsay Duncan, wants Mary to a private practice for gifted children fulfil her natural potential but downand is Visiting Professor at Middlesex to-earth Frank fears for Mary’s University. happiness.

An unhelpful dissection play Anatomy of a Suicide Royal Court Theatre

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This two-hour long (no interval) play, written by Alice Birch and directed by Katie Mitchell, is about three generations of women: mother (Carol), daughter (Anna) and granddaughter (Bonnie). Their stories are presented simultaneously, making them at times difficult to follow (your seat number largely determines which story you follow more closely), but it becomes immediately clear that this play is about suicide, and more specifically women’s/mothers’ suicide.

I was pleased that Alice Birch decided to use her brilliant artistic skills to ‘talk about’ suicide. People who, like myself, specialise in suicide research and suicide prevention are often frustrated about how little is available to people at risk for suicide and their ‘carers’.

My own experience on a theatre stage as a young woman made me really appreciate the amazing craft of what Birch and Mitchell achieved, as well as the performance mastery of the actors. The use of slow movements in between scenes, coupled with loud and evocative sounds, contributed to create a very dramatic experience (perhaps too dramatic for some, like my seat neighbour who cried for most of the time and the couple sitting in front of me who left after 20 minutes in a visibly shocked state). Yet, as much as I was pleased by the choice of topic and the theatrical qualities of the play, as a clinical psychologist who volunteers for Maytree suicide respite centre in London, and someone who has been personally touched by suicide, I was disappointed, perhaps even outraged, by its content.

In an online interview Birch mentions that she ‘went to speak to one academic who runs this suicide studies thing at Oxford University’. Hearing that, one is left wondering whether, if suicide is ‘the only one really serious philosophical problem’ as claimed by Camus, talking to one academic expert when writing a play on such a complex multi-layered, stigmatised and misunderstood issue is perhaps just too little. And if one academic it has to be, why not choose a woman and/ or someone expert in women’s suicide and gendered aspects of suicide? One such might have been Professor Silvia Sara Canetto (Colorado State University) with whom I had the honour to watch the play, together with Dr Bridget Escolme, from the School of English and Drama at Queen Mary University of London.

Bridget and I have been working together on an MSc in Creative Arts and Mental Health at QMUL, a course I currently co-lead, which has a particular emphasis on the representation of ‘madness’ and mental health experiences in theatre and performance.

After viewing Anatomy of a Suicide, I shared with Bridget my uneasiness with the way all three women in the play were represented. They were mad, unstable, extremely emotional and mean, as they made the lives of people around them miserable. As we chatted about the representation of women and womanhood in 19th- and early 20th-century theatre, I felt even more uncomfortable. Is not now, the 21st century, time to stop propagating an image of women as weak, crazy and

unbalanced? What is the underlying message that this play suggests? What is particularly problematic to me with this play is that the message given to the public is not only that suicide is possibly hereditary and (genetically?) transmitted, a hypothesis for which there is no sound scientific evidence; but also that women who are suicidal are mad (perhaps even ‘bad’), they have some dramatic personal struggle, and are fundamentally unable to live and cope with their traumatic experiences. By contrast, the men in the play are stable, caring, loving and present, and eventually mistreated by the women. In the play Carol treats her husband John very poorly, Anna has basically destroyed John’s (her father’s) life and drugged and had sex with the 15-year-old brother of his (male caring and calm) friend, a junior doctor; and Bonnie is mean to basically every person in her life.

In English-language countries, including the UK, the dominant ‘cultural script’ of a suicidal woman is very different to the dominant script for a suicidal man. As Silvia Sara Canetto put it in our post-play discussion, male suicides are typically interpreted as the result of social and economic ills. This was certainly the case in another play I watched a few months back at the National Theatre called The Suicide. So, when a man wants to kill himself, it is basically because he is victim of some social injustice, discrimination or other life circumstances out of his control like unemployment, poverty and racism.

But a woman who is suicidal is typically presented as just unable to ‘pull herself together’, having ‘lost her mind’ and with ‘something wrong with her’, concepts overwhelmingly present in The Anatomy of a Suicide.

Too many women who have tried or contemplated suicide have heard such views way too often.

Other words we also hear often in this play are ‘I’m sorry’ and ‘No’. The former, repeated several times by all three women, suggests an internalisation of the cultural script about them (as the guilty one, the one to blame, the one who has got something wrong with them).

The latter is about their repeated rejection of attempts to

the psychologist august 2017 culture help them. This suggests, first of all, that people at risk of suicide have people around them who care for them and are there to help. And while this is true for some of them, it is definitely not so for many of the people I have encountered in my 20+ years experience in this field, across several countries. Secondly, it potentially justifies the use of compulsory/involuntary treatment. In two scenes, both Carol in the 1970s and Anna in the 2000s receive electro-convulsive treatment to attempt to ‘cure’ their suicidality. ECT is an extremely invasive treatment that is usually seen, or should be seen, as the last resort to deal with severe mental illness, and it was unfortunate that Birch decided to portray only this as a potential treatment for suicidality. I could not avoid thinking about the impact that seeing a young woman in convulsions on a hospital bed as result of ECT might have on a member of the public who is suicidal and considering seeking help – a high chance given that suicide is the leading cause of death of British men under 50 years of age and on the rise also among English women.

Leaving the theatre, I felt that an interested but uninformed member of audience would exit with confirmation of their cultural scripts of woman and womanhood, and for a suicidal woman as someone troubled and troublesome. They would also have acquired

film Wonder Woman Patty Jenkins (Director)

the unfounded knowledge that suicide is transmissible and, as such, inevitable unless hard measures are taken, such as sterilisation.

‘Suicide is not inevitable. Suicide can be prevented.’

This is a slogan that we repeat daily. But suicide can only be prevented if we understand and counteract the individual as well as socio-cultural-political forces that determine an individual’s ‘choice’ to take their own lives… whether a man or a woman. This play had all the potential to provide a social analysis of suicide and contribute to stimulating the public to be part of that discussion and do their part to save lives. Instead, although very well crafted, it perpetuated unhelpful views.

I do hope to see more plays on suicide. I strongly believe in the power of arts and theatre to challenge the status quo of stigmatising social representations and improve a fundamentally inadequate mental health system. But I also hope future playwrights will do a bit more reading before writing, and consult with some of the thousands of people who are touched by the painful experience of suicide on a personal and/or professional level.

Reviewed by Dr Erminia Colucci, who is at Queen Mary University of London

A resonating message to humanity?

Princess Diana of the Amazons is the embodiment of our desires. Strong, beautiful, honest, kind and here to save our deteriorating species from our own hubris. The irony that her sheer trust in humanity stems from growing up far away from ‘civilisation’, makes her story arc even more compelling.

In Jenkins’s adaptation, Diana is not simply a woman faced with the realities of life – she is beyond us. A skilled warrior and a brave ally, she outfights any man. What’s more, she doesn’t understand the backseat her female counterparts take in ordinary human life.

‘How do women fight in these clothes?’ she asks when

forced to discard her battle armour to blend in to the WWI London scene. Diana’s learning curve is to keep faith, no matter humanity’s inability to change. In Wonder Woman Psychology [see our website for an extract], Travis Langley explains how her creator – the psychologist William Moulton Marston – was convinced of female superiority over men, believing women were the key to peace.

It’s no wonder Hollywood was willing to catch a ride on the bandwagon of female empowerment. To win a box office success and gain a female audience has been a long- term aim. Hollywood’s greatest audience, after all, are 15- to 24-year-old men, their desires greatly influencing what is seen on the silver screen. Laura Mulvey has described this trend, and consequently female characters in film, as the symbol of our patriarchal society; the castrated woman forming the ultimate phallic object. It is clear that Jenkins struggles with this very aspect. Her lead character is both empowered, judging the lack of functionality in women’s fashion, yet sporting tight, revealing armour and fighting in heels herself; a pioneer in independence, yet a character that abides by every Hollywood standard of age, race and body type.

Diana is an extraordinary woman in every aspect, which makes her removal from ‘real’ women painfully poignant.

It might be a long, painful journey to equality, on- and off-screen, but the film and character form both a quiet criticism on how our testosterone-driven actions form the ugly side to our species, and a gentle reminder of our ability to change for the better.

Reviewed by Tess van Leeuwen, King’s College London

the

psychologist

AZ to

H

...is for Habit

‘I’m fascinated by how much influence habits have on what we do and, thus, who we are. Much of our day we’re all running in autopilot, having some crude, internal gratification-algorithm react on environmental cues – and most of the time we don’t even notice that. Have you ever suddenly stopped, thinking “What was I doing right now?”’

Why is it so hard to kick a smoking habit?

In her May 2013 article (and accompanying video), Lynne Dawkins explained how cues closely associated with the primary reinforcer – nicotine – can come to be strongly reinforcing in their own right.

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According to the ‘habit discontinuity hypothesis’, behaviour change interventions may be much more effective when people have gone through a major lifestyle change due to which their habits have been discontinued.

Karla Novak

Suggested by Marco Meissner, a psychologist running a coaching and training business. @grow_and_shine

(See our September 2012 piece on ‘the psychology of sustainable transport’.)

Episode two of our Research Digest podcast PsychCrunch looked at ‘Breaking bad… habits’.

Interviewees discussed the ‘Mindbus’ technique, and switching hands to eat less popcorn.

As part of our 2011 feature on ‘the deadly sins’, Christian Jarrett considered sloth in terms of habitual ‘task avoidance’; a view perhaps reflected in our editor’s accompanying online confession…

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