The Psychologist Annual Conference 2014 Special Edition

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the

psychologist special edition

annual conference 2014

Annual Conference 2014 An archive collection of some of the speakers at this year’s British Psychological Society event

Child of our Time 2007 Chris French 2014 Incorporating Psychologist Appointments mirror writing 2012 £5 or free to members of time to forget HM? 2013 The British Psychological Society

‘them and us’ in mental health 2010 the anarchic hand 2005 Marinus van IJzendoorn 2014 for more, see www.thepsychologist.org.uk

INTERVIEW

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extreme sceptic. I had the attitude that all parapsychologists were incompetent, that all self-proclaimed psychics were deliberate frauds, that no aspects of paranormal belief were beneficial, and so on and so forth. All of those things I now think I was wrong in thinking. I think we have a natural human tendency to see the world in black-and-white terms and I was Chris French tells Lance Workman about his journey into weird stuff falling victim to that. I now think there are certain paranormal claims that should be taken seriously by the scientific world.

I’m not saying that I believe they have established that paranormal forces exist – but the evidence is not as weak as the ou started out in neuropsychology, wider scientific community might I still occasionally come across the but over the years you’ve become assume. Again I think it’s worth taking attitude ‘We all know it’s nonsense, so well known for anomalistic psychology. why do you study it?’ Well, there are such claims seriously because, if the Talk me through this transformation. wider scientific community is correct various reasons. For example, most My PhD, which was at Leicester to be sceptical and to assume that people believe in this stuff and a sizeable University, used EEG to look at paranormal forces don’t exist, then it minority claim to have had direct hemisphere differences, so it’s very gives us great insight into the strengths experience of it. As psychologists, we need much a neuropsychological background. and weaknesses of the scientific process to explain this. Also the fact that there’s Subsequently I’ve worked in a number of itself – issues that arise with respect to a multi-billion dollar industry built areas. I’ve done quite a lot of work with appropriate statistical around it and that my wife Anne Richards on cognition and analysis, whether people base important emotion but then developed this interest appropriate controls have decisions about health, in the psychology of, for lack of a better been used, publication relationships and “Sceptical voices are phrase, ‘weird stuff’. Initially it started off bias and replication financial investments on heard a lot more than they pretty much as a hobby or side interest. issues. All of those it means we can’t just used to be” I would do occasional lectures on it and kinds of things arise ignore this area and these went down well with the students. with a vengeance in pretend it’s not there.

Then I’d do occasional student projects parapsychology. So when I’m How can people come to believe looking at various aspects and it kind of teaching about anomalistic psychology astonishing things, like they have been grew from there. And now it is the main I like to look at the strongest evidence contacted by aliens or have regressed focus of my research. I used to have a bit and give my reasons why I’m still not to a past life? of a dilemma about what I called myself convinced by it. Also, at the other end There’s a multitude of reasons for these because when people asked me ‘what is of the spectrum, I like to look at what your research interest’ and I would say ‘it’s beliefs. One of the good things about I would consider to be extremely weak anomalistic psychology is that we can the psychology of paranormal beliefs and evidence in favour of paranormal claims, ostensibly paranormal experiences’, which cherry pick from all of the other because that gives us a great insight into subdisciplines of psychology. So if we is a bit long-winded. So I took to using everyday reasoning that people use to look at alien abduction, I think the main the term ‘anomalistic psychology’ – come to the conclusion that they have explanation is the development of false I didn’t come up with it but I think it best had a paranormal experience. But maybe memories – then the whole psychology describes what I do. So now I say ‘I study there are other much more plausible nonof false memories comes into play and anomalistic psychology’ and they say paranormal explanations available. lots of cognitive research underlies that.

‘What the hell is that?’

I’d be interested to know what do you Also there’s lots of work on individual Was there one key event or person think about Rupert Sheldrake’s claims differences that shows different kinds of that planted this seed of interest in that he has demonstrated things like personality factors might be involved. telepathy, given he was a senior There’s various kinds of anomalistic psychology?

Absolutely, I used to be a believer in science academic. neuropsychological explanations that I think Rupert is a very articulate and most of these kinds of claims. Then, when might lead people to believe they may intelligent proponent for the other side of have been abducted by aliens. One of I was doing my PhD, I read a book called the argument. I’m actually a closet fan of the most common explanations is sleep Parapsychology – Science or Magic? by Rupert Sheldrake. I don’t think he’s right paralysis – they put that experience down James Alcock, a Canadian social – but I think the reasons he is wrong are to alien abduction as an explanation. psychologist. It dealt with all of the kinds really interesting. He is one of those rare of thing I was very much interested in – In one of your articles you describe individuals who has the golden touch but from a sceptical perspective and yourself as a ‘relatively moderate when it comes to demonstrating offered explanations in non-paranormal sceptic’. Can you unpack that for me? ostensibly paranormal effects. I always terms. It made me realise there was a find that when I try to replicate his effects As a teenager I was interested in this sceptical literature, but at that time it was we don’t get the same results – which is kind of thing, and there was no sceptical quite hidden so it was difficult to track interesting. I think of Rupert as a personal literature out there so I pretty much down. I started subscribing to sceptical friend, and I wondered why he got believed it all. When I read Alcock’s book, magazines and got involved in sceptical positive results and I don’t, so I suggested it was my epiphany, and I became an conferences. It grew from there.

An anomalistic psychologist

Y

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let’s do something collaboratively. But those collaborative studies have never produced replicable statistically significant results. One of the problems of course in general is that researchers are far less inclined to write up failed replications than they are to write up significant ones. Also journals are far less likely to publish failed replications.

Can you give me an example here?

Yes, as you may know the well-known social psychologist Daryl Bem published a study in 2011, in a very well respected journal, that consisted of nine studies that demonstrated precognition, that is, that, in a sense, people can predict the future.

He claimed that, whereas we all know that if you give people a list of words that is presented only once and another list of words that they are allowed to rehearse they will remember the rehearsed words better than the unrehearsed words. Bem’s results showed that, even if you do the rehearsal after they have been tested, they will still perform better. So the claim here was that, in some mysterious way, the effects of the future rehearsal can reach back in time and improve your performance. Now we were intrigued by this – that is myself, Richard Wiseman and Stuart Ritchie – and we agreed that we would each carry out an independent study [see also tinyurl.com/psycho0512].

Bem asked for replication studies and very kindly made his software available.

We didn’t replicate his findings, but when we wrote up our results and sent the paper to the Journal of Personality and Social Psychology the editor politely rejected it without sending it out for peer review. We thought this was not acceptable given the original paper had caused a huge amount of media coverage and it had made an explicit appeal for people to try and replicate the effects. We then got the same treatment from Science Brevia and from Psychological Science.

We then sent it to the British Journal of Psychology where it was sent out for review – but it was rejected. One of the referees was very positive about it, but the second referee had reservations and rejected it. It turned out the second referee was Daryl Bem! Fortunately, PLoSOne did decide to publish it which meant we were eventually able to make our point. I think this experience raises issues…

How can psychology possibly move forward if many journals won’t publish failures to replicate studies! It’s almost as if ‘this has been shown therefore we can tick that box and move on’. Moving on ourselves, one phenomenon you’ve

looked into is near-death experiences.

Can we explain this in scientific terms?

I think there are two major hypotheses about near-death experiences. First, is that near-death experiences are exactly what they appear to be – the person is having the experience that consciousness has left their physical body, that they have had a glimpse of the afterlife. The second way to explain it is what is known as the ‘dying brain hypothesis’. This is the idea that it is a hallucinatory experience with all of the experience happening inside the person’s head. Now each of those components of that experience does occur outside of near-death experiences and there are plausible proven explanations in terms of what was happening in the brain at the time.

In terms of trying to support the paranormal angle, if you could prove that people really were able to pick up

information from remote locations that they couldn’t possibly have known about in any other way that would be a real challenge to sceptics. I’m a great supporter of these studies that are going on in hospitals around the world where there are targets that are at vantage points high up in hospital wards that you can only see if you are high up. So far those experiments have been going on for several years and no one has yet reported one of these hidden targets. But we’ll see.

There is certainly lots of anecdotal evidence – but it does not seem to stand up well when studied scientifically.

You’ve appeared a lot on TV and radio looking into paranormal beliefs. Has anything ever happened during one of these that really does open the door to the paranormal?

In all of the studies that we have done and all of the TV and radio programmes I have taken part in there has been very

read discuss contribute at www.thepsychologist.org.uk

very little that constituted a real challenge to my scepticism. But then again there are one or two TV programmes I’ve done where at the end of it I’ve put something in a mental box with a question mark next to it. To give you an example – there was one case of a programme where a man called David Mandell claimed he had dreams that could foretell the future and he would paint pictures about what is going to happen. As he was an artist he could produce quite good representations of what was going to happen. Some of the examples include the Twin Towers collapsing. He painted this twice, one of which was five years before it happened.

He would go down to his local bank and have his picture taken with that painting and that day’s newspaper. Spookily enough the date was 11th September.

That kind of thing could just be coincidence. The depiction did not correspond exactly to how it happened – but it was pretty close and difficult to explain.

As a (kind of) sceptic do you think we are moving in the right direction, or do you think we are more open to believe whatever we are told these days?

There has been a polarisation.

There’s no doubt that sceptical voices are heard a lot more than they used to be. On the other hand there is no evidence of any fall-off in belief in things new age and paranormal.

I think it’s down to a lot of factors, the internet being the main one. People can now pass information and ideas on and get together more easily. One of the things that I’m most pleased about is so many cities now have a ‘sceptics in the pub’ evening where someone will come along and give a talk and people can question them. Also I’m delighted that the AQA’s psychology syllabus has anomalistic psychology as an option. So lots of kids are asking questions about the quality of the evidence they have been given. Personal experience is generally seen by people as the most reliable form evidence, but as psychologists we are aware that people misremember, misperceive and misinterpret. We need to get people to question things using the most appropriate critical thinking tools.

Finally you’ve done a great deal, but is there anything that you still have burning ambition to do?

Burning ambition is the right term – I would really love to do a fire walk!

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ANT maintained that ‘freedom of the will’ is one of the metaphysical issues the human intellect is not fit to tackle. I hope at least to add a tiny tile to the complex mosaic of ‘will and actions’, through the perspective of cognitive neuroscience. I will discuss the cases of people whose intentions to act are hindered by actions they perform apparently against their own will. These people behave as they do because of lesions in particular regions of the brain, the frontal lobes.

One evening we took our patient, Mrs GP, to dinner with her family. We were discussing the implication of her medical condition for her and her relatives, when, out of the blue and much to her dismay, her left hand took some leftover fish-bones and put them into her mouth (Della Sala et al., 1994). A little later, while she was begging it not to embarrass her any more, her mischievous hand grabbed the ice-cream that her brother was licking. Her right hand immediately intervened to put things in place and as a result of the fighting the dessert dropped on the floor. She apologised profusely for this behaviour that she attributed to her hand’s disobedience.

Indeed she claimed that her hand had a mind of its own and often did whatever ‘pleased it’. This condition is known as anarchic hand: people experience a conflict between their declared will and the action

K

SERGIO DELLA SALA on the bizarre ‘Dr Strangelove syndrome’ and what it tells us about free will. of one of their hands. She is not the only person with this bizarre syndrome. Another such patient had problems in choosing TV channels, because ‘no sooner had the right hand selected one station the left hand would press another button’ (Parkin, 1996).

Anarchic hand is one of the most intriguing phenomena in neurology. The complex movements of one hand are apparently directed towards a goal and are smoothly executed, yet are unintended (according to what the affected people say).

The patients are aware of their bizarre and potentially hazardous behaviour but cannot inhibit it. They often refer to the feeling that one of their hands behaves as if it has a will of its own, but never deny that this capricious hand is part of their own body.

The bewilderment comes from the surprising and unwanted actions, not from a sensation of the hand’s not belonging (Marchetti & Della Sala, 1998). This condition seems to demonstrate that selfownership of actions can be separated from awareness of actions. The patients affected

‘ANARCHIC HAND’ IN FICTION The theme of a hand with a will of its own has captured the imagination of several movie-makers and writers.

WARNER BROS/FIRST NATIONAL/ THE KOBAL COLLECTION

The 1935 film Mad Love was based on a Maurice Renard novel about a pianist whose mutilated hands had been surgically replaced with those of a criminal which then acted on their own will.A pianist’s severed hands cropped up again in the 1946 film The Beast with Five Fingers, and portrayals continued through the 1960s (The Nutty Professor, Dr Strangelove), 1980s (Evil Dead 2) and 1990s (Body Parts, Idle Hands, and Me, Myself and Irene).

Peter Lorre in The Beast with Five Fingers

In Hemingway’s The Old Man and the Sea, the cramped hand would not conform to the old man’s fish-catching endeavour even when he gently entreated it to. Other examples abound.

Julio Cortazar, in one of the short novels of Octaedro, Cuello de Gatito Negro, portrayed a girl whose hand ‘does not want to listen and sometimes to her consternation does whatever it likes’. Maurice Sheridan Le Fanu in The House in the Churchyard, presented a disembodied hand trying to choke the hapless person it was persecuting.

are aware of the ‘actions’ of their anarchic hand, which they know to be their hand and not a robotic counterfeit, yet they disown them.

Anarchic hand is a symptom so grotesque that it verges on the comic.

Another patient of ours, Mrs GC, often complained that her hand did what it wanted to do, and tried to control its wayward behaviour by hitting it violently or talking to it in anger and frustration (Della Sala et al., 1991). Readers may appreciate the similarities with Dr Strangelove, the irreverent movie that Stanley Kubrick based on the novel Red Alert by Peter George, in which a mad German-American nuclear scientist, played

by Peter Sellers, constantly had to grab his right arm to stop it making a Nazi salute.

Dr Strangelove syndrome is the term by which anarchic hand is now known throughout the popular scientific press.

Anatomy Some of the literary and movie descriptions of anarchic hand (see box) neatly overlap with the anarchic patients’ feelings or reports. However, it was William Boyd, in his short story ‘Bizarre Situations’ in the collection On the Yankee Station, who embraced an anatomical interpretation of the syndrome. The main character of this novel does not know whether or not his left hand shot his best friend’s wife dead. He had undergone an operation known as callosotomy, where surgeons sever the bundle of white fibres that join the two cerebral hemispheres. Indeed, in the wake of the discovery of the specialisation of the left and right hemispheres, for many years a section of the corpus callosum (either surgically or due to a pathological process) has been held to be solely responsible for anarchic hand. Feinberg (1997) maintained that the key to the anarchic hand is the notion that you can have two consciousnesses in a single individual.

The idea that ‘Man is not truly one, but truly two’ (Stevenson’s Dr Jekyll and Mr

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Anarchic hand

Peter Sellers in Dr Strangelove

Hyde), perhaps half good and half bad as in Italo Calvino’s Cloven Viscount, is entwined with the history of humanity, and certainly is fascinating from the artist’s point of view. However, scientifically it is rather simplistic, and as an interpretation for anarchic hand it proved wrong. The callosal hypothesis of anarchic hand is slippery on more than one ground. Bear with me for a short anatomical digression.

Anarchic hand interpreted as a disconnection between the two hemispheres would result from the separation between the right hemisphere motor cortex (governing the left hand) and the left hemisphere areas devoted to planning and the correct execution of complex motor activities. Therefore the hand showing the anarchic behaviour must always be the left hand in right-handers. This assumption has

been debunked by the observation of righthanded patients with a right anarchic hand (see Goldberg, 1985).

So, if anarchic hand is not caused by inter-hemispheric disconnection, what does cause it? Our patient GC (Della Sala et al., 1991) who had right-sided anarchic hand, suffered a subarachnoid haemorrhage – the rupture of an artery within the brain – eight years before she came to us. Two days after the haemorrhage she was operated upon by a neurosurgeon who attempted to clip her broken aneurysm. As a result she had a stroke. She was left with damage in the anterior part of her brain, encroaching upon the medial area of her left frontal lobe.

We reviewed 39 detailed cases we could glean from the literature (Della Sala et al., 1994). It appeared that most of the patients showing anarchic hand had a lesion

FIGURE 1 Localisation of the premotor cortex (PMC) and the supplementary motor area (SMA) in the lateral and medial view of the left hemisphere

encroaching upon the medial wall of the frontal lobe contralateral to the wayward hand. In particular, lesions seem to be centred on an area known as the supplementary motor area (SMA). Each SMA lies in the medial surface of one of the frontal lobes (see Figure 1). It plays a role in the execution of movements. It is thought to be responsible for converting intention into self-initiated actions, or to be involved in the selection of what movement to make. Several studies converge in demonstrating that the part of the SMA known as the SMA-proper stores and organises motor subroutines related to internal drives.

Several physiological single-cell experiments point to the distinction between a lateral and a medial premotor system. The premotor medial systems centred on the SMAs are connected with a lateral motor system (centred on a region sometimes referred to as premotor cortex – PMC). This lateral system is considered to be responsible for the so-called responsive movements, which are generated in response to external stimuli. I will summarise for you one experiment I found particularly enlightening.

Mushiake et al. (1991) trained monkeys to press buttons in a given sequence. In one condition, the ‘external condition’, lights told the monkeys which button to press (it was a visually guided sequence). In the other condition the monkeys performed the sequence from memory with no external cues, this was the ‘internal condition’.

The movements made by the monkeys were identical. Yet the SMA cells were more active during the internal condition and the PMC cells were most active during the external, visually guided condition.

Neuroimaging studies provide us with further compelling examples. A series of experiments carried out in London (see Blakemore et al., 2002) showed that willed actions are associated with a clear activity in the medial walls of the frontal lobes.

These and other similar experiments indicate that the control of movements may vary as a function of whether the action is internally or externally guided. The SMAproper will dominate when the task is internally guided. In contrast, the lateral region becomes more relevant when the environment triggers the task. A neat account of anarchic hand could be given as a result from the imbalance of this complex mechanism: a lesion of the SMA leaves the contralateral hand at the mercy of external 607

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ANARCHIC VS. ALIEN Anarchic hand is often referred to in the literature as ‘alien hand’. However, alien hand is a different syndrome altogether.The confusion arose owing to a mistranslation from the French and dragged on in subsequent scientific reports (see Marchetti & Della Sala, 1998, for a full account).The term prevailed, and alien hand began to mean different things to different authors.

The abuse of the term alien hand is even more evident in the popular scientific press. For example, in a pamphlet Oliver Sacks calls a phantom limb ‘alien’ (Sacks, 1995, p.149); and in a TV documentary (The Mind Traveller, BBC2, 31 October 1996) described as ‘alien hand’ the typical involuntary movements and tics shown by a patient with a Parkinson-like disease.

stimuli that operate through the PMC, and it therefore behaves anarchically.

The ‘frontal’ account of anarchic hand makes sense if one considers the basic role of the frontal lobes in the human brain: to allow interaction with the environment. The development of the prefrontal cortex in humans is, in evolutionary terms, both recent and striking. Even in comparison with squirrels and rhesus monkeys, the relative proportion of the cortex occupied by the prefrontal region in humans represents an enormous increase. The comparative recency of the development of the prefrontal cortex is one of several factors that have led many to regard the region as the seat of what we believe to be our distinctive qualities of self-awareness. A lesion in the frontal lobes will produce a change in the character and habitual behaviour of the person – they will be at the mercy of environmental triggers

and will not be able to inhibit inappropriate behaviour. The person is not himself anymore. As poignantly described by Ken Kesey in One Flew over the Cuckoo’s Nest.

When McMurphy returned from having surgery to his frontal lobes, his mate bellowed: ‘Nothing like him.’

What a person does is not what they would have done before the lesion to their brain – they should not be held responsible for their actions, yet they are perfectly aware of what they are doing. The problem is so acute that Pope Pius XII declared against the practice of lobotomy to treat (change) socially unbecoming behaviour, maintaining that a lesion to the frontal lobes would strip a person of free will. This thorny issue was debated at some length by an ad hoc committee of ecclesiastics and scientists. They came to the conclusion that the freedom of will of people affected by

References Blakemore, S-J.,Wolpert, D.M. & Frith, C.D. (2002).Abnormalities in the awareness of action. Trends in Cognitive Sciences, 6, 237–242.

Boccardi, E., Della Sala, S., Motto, C. & Spinnler, H. (2002). Utilisation behaviour consequent to bilateral SMA softening. Cortex, 38, 289–308.

Della Sala, S., Marchetti, C. & Spinnler, H. (1991). Right-sided anarchic (alien) hand:A longitudinal study.

Neuropsychologia, 29, 1113–1127.

Della Sala, S., Marchetti, C. & Spinnler, H. (1994).The anarchic hand:A frontomesial sign. In F. Boller & J.Grafman (Eds.) Handbook of neuropsychology, Vol. 9 (pp.233–255).Amsterdam: Elsevier.

Feinberg,T.E. (1997). Some interesting perturbations of the self in neurology.

Seminar in Neurology, 17, 129–135.

Goldberg, G. (1985). Supplementary motor area structure and function: Review and hypotheses. Behavioural and Brain Sciences, 8, 567–616.

Lhermitte, F. (1983).‘Utilisation behaviour’ and its relation to lesions of the frontal lobes. Brain, 106, 237–255.

Lhermitte, F. (1986). Patient behaviour in complex and social situations:The ‘environmental dependency syndrome’. Annals of Neurology, 19, 335–343.

Lhermitte, F., Pillon, B. & Serdaru, M. (1986). Imitation and utilization behavior:A neuropsychological study of 75 patients. Annals of Neurology, 19, 326–334.

Marchetti, C. & Della Sala, S. (1998).

Disentangling the alien and anarchic

hand. Cognitive Neuropsychiatry, 3, 191–207.

Mushiake, H., Masahiko I. & Tanji, J. (1991).

Neuronal activity in the primate premotor, supplementary, and precentral motor cortex during visually guided and internally determined sequential movements.

Journal of Neurophysiology, 66, 705–718.

Parkin,A.J. (1996).The alien hand. In P.W. Halligan & J.C. Marshall (Eds.) Method in madness: Case studies in cognitive neuropsychiatry (pp.173–183). Hove: Psychology Press.

Sacks, O. (1995). Scotoma: Forgetting and neglect in science. In R.B. Silvers (Ed.) Hidden histories of science (pp.141–187). New York: New York Review Books.

such a lesion would be degraded, and advised against their becoming priests or receiving Holy Communion.

Even more bizarre?

What would happen if, rather than a unilateral lesion giving rise to contralateral anarchic hand, a person had a bilateral lesion damaging both the SMAs? The outcome would be another sign of frontal disinhibition known as ‘utilisation behaviour’, whereby patients show a compulsive urge to use objects at sight.

Lhermitte (1983), a French colleague, revamped this symptom. Among the examples he reported, my favourite is that of a 52-year-old lady who was sitting in the doctor’s surgery, when she spotted some medical instruments. She immediately picked up the syringe, Lhermitte was fast enough to take off his jacket and undo his trousers; she bent down to his buttocks to give the injection.

We have recently assessed a patient, with a bilateral lesion centred on the SMAs, showing overt episodes of utilisation behaviour (Boccardi et al., 2002). For instance, while being tested, he spotted an apple and a knife on a corner of the testing desk. He peeled the apple and ate it. The examiner asked why he was eating the apple. He replied: ‘Well…it was there.’ ‘Are you hungry?’ ‘No. Well, a bit.’

‘Have you not just finished eating?’ ‘Yes.’ ‘Is this apple yours?’ ‘No.’ ‘And whose apple is it?’ ‘Yours, I think.’ ‘So why are you eating it?’ ‘Because it is here.’ On another occasion the experimenter, while adjusting the video-camera, put his wallet on the table. The patient spotted the wallet, started to take out all the credit cards and other things, such as the national insurance number, reading it aloud. The experimenter asked: ‘Whose wallet is it?’ ‘Yours.’ replied the patient, a bit baffled by the question, but carrying on ransacking it. Indeed, his utilisation behaviour was so overt as to become a cause of embarrassment to his wife, and was her major complaint.

It looks as if by damaging one SMA a person ends up with anarchic hand; damage to both will elicit utilisation behaviour. In both cases the affected patients will perform inappropriate actions.

The environment triggers the actions performed by patients showing utilisation behaviour exactly as it does those of people with anarchic hand. However, those with utilisation behaviour are not aware that their behaviour is inappropriate, and they

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don’t show any conflict between wanted and unwanted actions. It may well be that the lack of awareness observed in patients with utilisation behaviour comes from the complete impairment of the medial system, while patients with anarchic hand still have some access to their inner ‘Fat Controller’ through the spared half of the system.

Think about a possible scenario that may apply to us all. One Saturday morning while driving towards a holiday site to spend your weekend you cross the usual road to your office. Absentmindedly you may turn and find yourself driving to the office for a while before recognising your error. The environment provided a trigger strong enough for you to initiate an automatic behaviour, which you had to inhibit to go back to your intended plan.

This is what often happens to people affected by utilisation behaviour who lack the capacity to inhibit behaviour triggered by the environment. When the actions performed go beyond the simple toying, manipulation and utilisation of an object, they are often referred to as ‘environmental dependency syndrome’ (Lhermitte, 1986).

Controlling the anarchist inside Severe forms of environmental dependency syndrome are observed in patients with large lesions in their frontal lobes (Lhermitte et al., 1986). Yet, nobody is really immune. Jonathan Miller, the British physician turned opera director, revealed a very pertinent autobiographical episode. He was standing by a road waiting for Queen Elizabeth to pass by, and he was scoffing at all those poor souls hopping about and waving their hands frantically at the triumphal black stretch-limousine. Yet, as soon as the mighty car approached his position he could not refrain from hailing the queenmobile. Disgorging nationalistic pride? More probably an automatic performance triggered by the environment that he failed to consciously inhibit.

Indeed, according to a recent neat model of the motor control system (Blakemore et al., 2002) the deficit responsible for anarchic hand and utilisation behaviour would reside in the lack of inhibition of these environmental cues which will generate unwanted actions.

From all that we have discussed so far,

DISCUSS AND DEBATE Does anarchic hand contribute to our understanding of consciousness?

Could neuroscience contribute to the discussion on free will?

Does the brain only allow room for a free won’t?

Has neuroscience got much to say to lawyers about personal responsibility?

Have your say on these or other issues this article raises.

E-mail Letters on psychologist@bps.org.uk or contribute to our forum via www.thepsychologist.org.uk.

it appears that neuroscience provides us with examples of inability to inhibit actions triggered by the environment. So can conscious will only veto undesired actions?

From this perspective it looks as if our brain may have a free ‘won’t’ rather than a free will.

■ Sergio Della Sala is Professor of Human Cognitive Neuroscience and Honorary Consultant in Neurology at the University of Edinburgh. E-mail: sergio@ed.ac.uk.

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INTERVIEW

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‘Children suffer… that’s what drives me’ Marinus van IJzendoorn met Jon Sutton at the European Congress of Psychology and talked about his research on differential susceptibility in child development

e’re here in Stockholm, where W I think the popular idea of dandelion children – those with ‘resilient’ genes who will do well in most conditions – actually originated.

The idea of dandelions and orchids originates from Tom Boyce, he used the metaphor. He might be a little distressed because it’s taken too literally. I agree – these may not be two classes, but a continuum of more or less openness to the environment.

Tell me how you came to it scientifically.

We were the first to do genetic research on the idea of differential susceptibility.

The idea was already around on a theoretical level, for quite some time, and in fact was most active in the mid-1990s.

The first studies were by Boyce and then Jay Belsky, but then it seemed to slow down a lot. We were entering into the field of genetics from the perspective of attachment theory, which is I think quite logical because attachment theory is based on evolutionary theory – it’s the first evolutionary theory applied to human development besides Charles Darwin himself. John Bowlby was the first evolutionary psychologist you might say, it’s now a very popular concept but he was the first to apply evolutionary thinking in a systematic way to human development.

So my colleague Marian BakermansKranenburg and I went into this area of genetic research after having done twin studies, and we found – by accident, in a way – this interaction between DRD4, a dopamine-related gene, and sensitivity to environmental influences on children, developing differentially positively or negatively. That got us on the way in a series of studies on differential susceptibility.

Am I right in thinking that two psychologists at King’s College London, Caspi and Moffit, had raw data and graphs in their 2002 and 2003 papers

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pointing to this idea, but it didn’t really get a foothold?

Well, their wonderful research prepared the way for gene by environment interaction research more broadly. But their study is really firmly grounded in the tradition of diathesis-stress and cumulative risk.

attachment here today.

It’s quite a short talk, so I decided to talk about some of our recent research on attachment, especially how adult attachment representations are related to responses to infant crying and infant laughter, and how that might be influenced by oxytocin. We are doing a series of studies with oxytocin sniffs.

We’re interested in how people with a certain attachment style end up being harsh to their crying child, or remain calm and sensitive. Oxytocin might be one of the key issues in the chain from cognitive representations to behaviour.

The idea being that it’s a kind of chemical spotlight, it makes social cues more salient?

Oxytocin is a hormone and neurotransmitter that is still not really determined in terms of its function. It’s being considered the ‘love hormone’, or the ‘cuddle chemical’, but again that’s a one-sided view. What we are finding is that it lowers the activity of fear centres, such as the amygdala, and elevates the activity of reward centres, such as the orbito-frontal cortex and the anterior cingulate cortex. But it is not effective in all people – we find that those with negative attachment experiences are less open to the effects of oxytocin. How that comes about, that’s one of the big puzzles we are working on now.

So in people who did not face severe or repeated stress, the risk alleles in question actually heightened resistance to stress and depression.

Carriers of risk alleles were more prone to develop, for example, anti-social behaviour or depression having grown up in a bad environment with lots of maltreatment experience. But the other side of the equation, the bright side, Caspi and Moffit didn’t touch on. So absolutely groundbreaking A researcher once did studies, because for the adult attachment the first time in the “there is a gap between interview on me, and human development brain and behaviour, which said I was the most area they opened up is very intriguing” dismissively attached the way of thinking person they had met! in terms of measured What would you predict for gene by observed my reaction to oxytocin, and to my poor environment interaction, but differential crying children? susceptibility is a two-sided Amazingly unscientific! The interview phenomenon – the same risk alleles is not meant to conduct individual would also create more options to learn diagnoses, errors of measurement simply from a positive environment. That’s quite forbid it. Well, what I’m going to present unique to the idea of differential is that without oxytocin, insecurely susceptibility and to the research that we attached adults feel firstly more irritated did in Leiden. by infant crying behaviour. Secondly we And it was about that time that positive have a hand-grip measure, we teach the psychology was coming to the fore, so participants to exert full force and then you were surfing the zeitgeist of we teach them to go for half-strength. looking on the bright side!

They manage to do that. And then we It might be that it’s not by accident – have them listen to cry sounds. Insecurely about that time more people started to attached individuals exert excessive force do research on the positive side of more often than the securely attached development, but again one-sided studies, parents, when listening to this aversive of positive development in positive crying. environments. But it is the power of the So that’s not necessarily expressing idea of differential susceptibility, that it anger, it could be discomfort, that they covers both streams of research. find that more aversive.

So tell me how you’re linking it with Yes, and what in practice the response

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would be. It could be an alarm signal that A lot of your research is still very is more pronounced, it might also trigger hands on with children and parents harsh parenting. Crying behaviour is and behaviour, it’s important not to primordial attachment behaviour, it’s one take it that level of abstraction too far.

These are absolutely fantastic times to of the first behaviours that an infant can study parenting, with big advances in show to display discomfort, distress, genetics, in brain research, in hormonal stress… it’s a proximity seeking behaviour, which John Bowlby wrote about quite extensively. But it’s also a trigger for harsh parenting and child abuse, an epidemiological study showed that aversion to crying in the first half year is the stimulus for about 6 per cent of young mothers to slap the child, to smother the child, to really go into the direction of child abuse. You might imagine that it’s a powerful trigger, because persistent crying is really a nuisance, that’s for sure, for any person, but some people might have a lower threshold to react in a harsh way. What we see in the scanner is that listening to cry sounds compared to control sounds elevates the level of amygdala activation, because it’s aversive, and oxytocin lowers that level of activation.

What we hoped to find was that it’s a mediating mechanism between attachment representation Professor Marinus van IJzendoorn, Centre for Child and to those feelings of irritation Family Studies, Leiden University, The Netherlands and excessive force on the hand grip. We didn’t find that, VANIJZEN@FSW.leidenuniv.nl so there is a gap between brain and behaviour, which is very intriguing. research. It all creates lots of opportunities So it’s not as simple as intervening on to look at the mechanisms, the processes that pathway with a sniff of oxytocin of how exactly parents are influencing when your baby starts crying. children in their development, but we Exactly. We can’t really connect the three should refrain from using those types of parts of the equation to each other… devices for their own sake, because it’s that’s not unique to our lab, in the fMRI fancy, because it’s creating these nice area the dominant paradigm is looking at pictures. It’s always a means to a goal and the brain as a dependent variable, so what that goal is to understand better what happens in the brain is the end product of happens between parents and children a series of stimuli. For me this is totally and to know more about how to intervene unimportant, because what happens in families with an environment that is between your ears, no child or infant will not so great for the child to grow up in. ever see. What’s important is how specific In terms of creating positive brain activity is expressed in behaviour. environments, what do you think we I’m interested in parenting, in child can learn from the Scandinavians, behaviour, I would like to know how given that we’re here in Sweden? In brain activation affects parenting style and the UK I think people look to here for how it’s made visible to the child, shaping an example of how it should be done; the course of development. That’s really whereas in the UK some people say a big puzzle still, and not even addressed ‘we go out to work and get paid badly in a lot of the neuroscientific studies on so that we can pay other people badly parenting.

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to look after our children badly’.

In Scandinavia the parents really seem to have the choice to be at home, both parents, to care for their infant in the first year of life. In the UK and other countries, maternity and particularly paternity leave is very brief, so people are obliged to have other forms of care.

From the perspective of attachment theory there’s a misunderstanding around the concept of monotropy.

There’s lots of evidence that children are able to grow up in a network of attachment relationships. Sarah Hrdy has written about the survival value of alloparenting. It takes more than one person simply to collect all the food needed to have a child growing up to a reproductive age. You need a village to raise a child. So nothing against more caretakers in the environment of the child. The point is that in the first year of life, children are easily overwhelmed by all kinds of stimuli, they need more structure than older children. They are dependent on the moderation of stress by persons in the environment that they can rely upon. Attachment figures are in fact external stress moderators for infants in the first year of life.

Now if you put them into group care, that’s really quite some stressful experience. Some children won’t be bothered at all, depending on their temperament, but others will be. If parents don’t have the choice of staying at home, I think that’s bad, that’s not enough options for parents of susceptible children who might need to be at home.

The ‘orchids’?

Maybe, yes. So that’s what I find distressing in the US, the UK, in Holland, that parents don’t have the freedom to choose.

The second issue is of course quality of care. You can have bad care in both family and daycare environments with detrimental effects on the most susceptible children. In Scandinavian countries they seem to have strong regulations, and monitoring of them, to keep quality of care high. That’s a lesson we should learn. Young children are worth this investment, according to economists like Heckman.

You’ve researched a huge range of topics, from the aftermath of genocide through sleeping children to adoption.

What’s the common thread, what values drive you in that work?

The most important perspective is the influence of the environment, parenting and the family context on child

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development. You know of course the book by Judith Harris, that parents are not important at all because it’s all genes which drives development? There’s now a very popular book in Holland by Dick Swaab called We Are Our Brains. So in the past 20 years we witness a very strong main current that defines child development as a kind of autonomic process driven by genes and brain structures, with only marginal influence for the environment – prenatally, maybe, but whether after birth the work is really done, that’s what I doubt.

reading

That recovery, that resilience, brings us back to the positive and negative effects of the environment… it’s not too late to intervene.

Differential susceptibility theory makes clear that some children are quite robust, it doesn’t matter too much what environment they’re raised in as long as it meets minimum standards. That’s quite hopeful because there’s quite a few ‘just

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Bakermans-Kranenburg, M.J. & Van IJzendoorn, M.H. (2011). Differential susceptibility to rearing environment depending on dopamine-related genes. Development and Psychopathology, 23, 39–52.

Bakermans-Kranenburg, M.J. & Van IJzendoorn, M.H. (2013). Sniffing around oxytocin.

Translational Psychiatry, 3 e258. doi:10.1038/tp.2013.34 Van IJzendoorn, M.H. & Bakermans-Kranenburg, M.J. (2012). Differential susceptibility experiments: Going beyond correlational evidence. Developmental Psychology, 48, 769–774.

JIM WEST/REPORTDIGITAL.CO.UK

So you’re driven to counter that at a personal level as well as a scientific level?

Neglect of the environment is a big misunderstanding and, in the end children suffer… That’s what drives me.

If you follow it through, with the brain as ultimate cause of any developmental process, you can’t even criticise that children grow up in an orphanage environment. We did studies in orphanages in different parts of the world, and what we see is that for every single month they stay in that environment there is a bigger lag in their development of weight, height and head circumference compared to their peers growing up in families. Cognitive development goes into the range of mental retardation. If they are adopted, you see a tremendous catchup in cognitive development, IQ recovers to a normal level, a difference of 15–20 IQ points. This would be hard to explain on the basis of genes and brains being the causal drivers of development.

taking you next?

There’s distressingly little experimental research done on gene by environment interactions. We were the first to do a gene by environment experiment – changing the environment and seeing how that interacts with genes. It’s so much more powerful statistically. We have to work on better assessments of the environment, better assessments of genotype (for example genetic pathways), but also better designs to be able to really test and examine differential susceptibility and gene by environment interplay in general. So what we would like to do are large-scale experimental studies in which we have a closer look at the mechanism itself. We plan to use fMRI as a pre- and post-test assessment, to see if differences in brain activation mediate the effects of our intervention on the behaviour of parents and children. It is trying to get a more detailed and mechanistic view of how interventions work more effectively in certain subgroups of participants who are more open to the environment.

I think we’re going to continue our work with the oxytocin sniffs, because it’s intriguing how it is moderated by childhood experiences. It’s still shown in only three or four experimental studies. This is shaky in terms of the Potential is going to be wasted if we feel it’s assessment of childhood experiences, only genes and brains that create development so the first step will be to see how it is moderated by adult attachment representations, but it would be great if we could also include it in longitudinal part of those who study the environment. studies where we may observe negative You need a concept like differential childhood experiences moderating the susceptibility to study, in detail, the effects of oxytocin. interactions between the two facets.

good enough’ environments around. But there are also a lot of children who are very open to environmental pressures, these orchid children, who would really flourish in a better environment. That potential is going to be wasted if we feel it’s only genes and brains that create development. It’s a waste of talent, a waste of potential, if we are seduced by a deterministic view of child development.

Genes are important, but it’s the interplay with the environment, and too often that’s lip service – on the part of those who study the genes, and on the

Have you had your own behavioural genes assayed, or would you not think that’s important because it all depends on the interplay anyway?

These concepts, genes and environment, they all work on the level of samples, they don’t work on the level of the individual. It’s a misunderstanding if you feel one might predict the individual course of life on the basis of candidate genes, one gene in more than 20,000, without any insight into the environment… but even if you had exact information about the environment past and present, I still think on the individual level prediction would be quite disappointing.

Looking to your own future, can you predict where this research path is

Is there a lot of funding in that area?

We just received a seven million euro grant from the national science foundation to conduct experimental studies on differential susceptibility. But the pharmaceutical industry is not really interested in our oxytocin research. I just read Ben Goldacre’s Bad Pharma and felt lucky that industry does not see any profit in oxytocin. Maybe this is the reason why published results of oxytocin studies are diverging and sometimes disappointing. Our recent meta-analysis in Translational Psychiatry shows the problems of clinical applications of oxytocin. I love to do independent research because it is difficult enough without a big company looking over your shoulder and having an interest in the outcome.

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february 2014

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Annual Conference 2014 The keynote speakers for the conference are: Professor Sir Simon Wessely best known for his work on unexplained symptoms, syndromes and military health

Ben Shephard a military and medical historian, author and documentary maker

Susan van Scoyoc a psychologist specialising in psychotherapy, has worked within the legal system for over a decade

Professor Marinus van IJzendoorn recipient of awards for his research on attachment and emotion regulation across the life-span

Professor John Aggleton uses anatomical, behavioural and clinical methods to understand how brain regions interact

Registration is open – earlybird rates are available until 27 March Our programme timetable is now available to download

7-9 May 2014 International Convention Centre, Birmingham

www.bps.org.uk/ac2014 ‘big picture’ pull-out www.thepsychologist.org.uk

i

OPINION

Voices of the vulnerable Broadcaster, journalist and psychology student Sian Williams reports from the frontline on the responsibilities of broadcasters towards those they interview

references

T

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Evans-Lacko, S. et al. (2012). Mass social contact interventions and their effect on mental health-related stigma and intended discrimination. BMC Public Health, 12, 489.

Holstein, J.A. & Gubrium, J.F. (2004). The active interview. In D. Silverman (Ed.) Qualitative research (2nd edn, pp143–161). London: Sage Oakley, A. (1993). Essays on women, medicine and health. Edinburgh:

uncomfortable it felt.

So, the interview was broadcast, won plaudits and was listed among the best ever broadcast interviews by the Radio Times. Less than a year later PC David Rathband killed himself.

Opening the ‘sluice gates’

The brilliant US broadcaster Studs Terkel says the job of a radio interviewer is to mine for the ‘precious metal’ in an individual, and that questioning should take the form of a casual conversation, but one in which ‘in time, the sluice gates of damned up hurts and dreams (are) open’. The motive is to provide an entertaining, informative broadcast, revealing ‘He wanted to talk about what had happened to him, to raise the life experience awareness and funds for a charity he’d set up for other injured of others, so the officers, called the Blue Lamp Foundation’ audience can better understand what lies enough to give informed consent. What behind those ‘hurts and dreams’. constitutes ‘informed consent’ in the But the mining process sometimes context of someone who has experienced severe trauma, or who has a complex mental health problem, is not, I’d argue, a question asked by every news journalist, Edinburgh University Press. who are sent out to report on a breaking Skehan, J. et al. (2006). Reach, awareness story and quickly gather the thoughts of and uptake of media guidelines for those involved. reporting suicide and mental illness: An Australian perspective.

International Journal of Mental Health Promotion, 8, 4.

Teplin, L. et al. (2005). Crime victimisation in adults with severe mental illness.

Archives of General Psychiatry, 62, 911–921.

Interviewing objectives In nearly 30 years at the BBC, I’ve interviewed many people at violent or traumatic events, from the Hillsborough Stadium disaster, to the Paddington rail

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hree years ago I interviewed PC David Rathband, who as an unarmed policeman sitting in his car had been shot and wounded by the gunman Raoul Moat. He was blinded permanently by the attack and some of the shotgun pellets were still embedded in his face. He wanted to talk about what had happened to him, to raise awareness and funds for a charity he’d set up for other injured officers, called the Blue Lamp Foundation.

He was in training for the London Marathon and doing endless runs tethered to a sighted police colleague; but when he ran, he did so in darkness and he loathed it. Raoul Moat, David said, was constantly on his shoulder, no matter how far he went and how hard he pushed himself. During the hour-long interview, David talked about his visions and nightmares. How the picture inside his head was relentlessly dark and ugly. How he felt less of a father and husband because he could do nothing for himself.

How his police uniform was hanging in his wardrobe, yet he didn’t know how and when he could put it on again.

It was an emotional interview, David cried and often reached for my hand. He couldn’t see my producer and he wasn’t aware of the microphone, all he could hear was my voice. I asked whether he was comfortable that such an intimate and personal conversation was going to be edited to less than a quarter of its length, and broadcast on Radio 4 to more than two million people. He said yes, he wanted his story heard, however

leads journalists like me, to ask questions of our role and responsibilities in interviewing those who are defined, in 2011 guidelines published by Ofcom, the broadcasting watchdog, as ‘vulnerable people…those with learning difficulties… mental health problems…the bereaved… people who have been traumatized or who are sick or terminally ill’.

Both Ofcom and current BBC editorial guidelines stress the importance of providing ‘a voice to people confronting complex challenges’. They warn against using discriminatory language and urge careful reporting of suicide. However, much of the news media tends to focus on whether the contributor is well

opinion

crash, to the Asian tsunami and the In 1954 Gordon Allport suggested psychologist contacted the team Pakistan earthquake. My role involves four factors to help reduce prejudice: afterwards to say that removing the item getting something on-air fast, and that equal status, common goals, intergroup without warning had caused him distress. often entails talking to people who are cooperation and support of authorities.

Those with a mental health problem still in shock. In longer, recorded A recent meta-analysis (Evans-Lacko et may also believe themselves to be of interviews in a studio context, there is al., 2012) showed that if there is social lower status, may worry about being more time to discuss what to ask and how contact that meets all of Allport's judged and could struggle to perform well to ask it with the editorial team. There’s conditions, it could help reduce stigma in an interview context. Their story could also the chance to conduct relevant and discrimination. research. However, the objective is the Knowing or meeting same – to get an interview that will someone with a mental “What constitutes ‘informed make the audience think. illness is a powerful way consent’ in the context of someone In semi-structured interviews to improve attitudes who has experienced severe trauma, conducted in a psychological setting, and behaviours. or who has a complex mental health researchers collect information and In Australia charities problem, is not, I’d argue, a question interviewees are often seen as ‘passive and organisations that asked by every news journalist” vessels of answers…repositories of promote mental health are facts, reflections, opinions’ (Holstein using the ‘social contact’ & Gubrium, 1997). The power in the findings to try to bring I Sian Williams is in the final year of an MSc in Psychology and dyad in a broadcast interview, as in about attitudinal change is a trained Trauma Risk Management assessor a psychological one, is with the person towards people with mental asking the questions, but the health problems, through the journalist is often not trained to talk media. Journalists and to those who are vulnerable and is rarely broadcasters have been invited to meet be reshaped or their contribution dropped covered by a professional ethics code. psychiatrists and people with mental altogether, potentially affecting how they Also the giving of help is not the purpose health problems, with accompanying see themselves. of the interview. As Oakley (1993) educational programmes and joint team remarked: ‘What is good for the projects. Research and subsequent The power and the story interviewer is not necessarily good for guidelines on suicide and mental illness The media typically use medicalised interviewees.’ received national funding from June language, reducing an interviewee to Jack Douglas’s 1985 book Creative 2002, with briefings and the distribution a condition or problem. Words like Interviewing suggests using ‘strategies of books, quick reference cards and CD‘schizophrenic’ or ‘depressive’ can create and tactics’, based on ‘friendly feelings ROMs to media organisations. A study stereotypes and schemas, which, when and intimacy’, to optimise ‘cooperative, into the effectiveness of this strategy activated and left unchecked, can create mutual disclosure’. However, any found most respondents reported that discrimination or prejudice. disclosure in, or before, a broadcast there had been organisational change in When the charity, Mind, conducted interview is usually neither mutual nor attitudes towards mental health, with a survey in 2000 into how people with cooperative. The broadcaster’s objective ‘improved attitudes and confidence mental health problems thought they is not to offer advice, but to produce an among staff about reporting suicide and were viewed by society, half of the informative, entertaining interview. False mental illness and their improved respondents pointed to media coverage intimacy may be encouraged by the awareness of the key issues to consider’ as having a negative effect on their mental interviewer asking casual as well as (Skehan et al., 2006). health. In their submission to the Leveson directed questions, disclosing just enough Inquiry into the Culture, Practice and of themselves to gain trust, and thus Protecting the vulnerable Ethics of the Press, the Mind and Rethink provide stimulating radio or television.

The value of giving the vulnerable Mental Illness charities suggested that The broadcast environment, familiar a voice is clear. It enables people who are prejudice develops because of the to the interviewer yet unfamiliar to the not normally heard on mainstream media, language used in the media, especially interviewee, further strengthens the a chance to explain a lived experience, in print. People with mental health issues asymmetry. The control lies with the and challenge stereotype and stigma, if are sometimes described as a victim, or broadcaster; an interview can be cut from done with careful attention to the issues dangerous, with descriptive words used an hour to 10 minutes, with unpalatable and language. Personal and emotive like ‘psycho’ or ‘crazed killer’. Mind calls or controversial aspects removed, to testimony is a powerful way of engaging this the creation of ‘the dangerousness ‘protect’ the interviewee from adverse an audience and encouraging them to myth’, pointing to research suggesting reactions from the listener, or to shield think differently. What broadcasters need someone with a mental health problem the audience from unacceptable language to be aware of, is how to use that power is actually more likely to be a victim than or behaviour. If a taped interview is carefully. a perpetrator of crime (e.g. Teplin, 2005). changed, drastically shortened, or In the UK, there have been Even though studies highlight dropped altogether, this may heighten improvements in the way much of the print media as being most responsible an already vulnerable person’s anxiety media covers mental health issues over for creating the ‘dangerousness myth’, through ‘confirmation bias’ – the human the past few years, with many sensitive other media can perpetuate it. In a 2011 tendency to focus on evidence that documentaries and news articles. survey for Mind, only a third of over supports existing beliefs. One broadcast Guidelines for broadcasters on reporting two thousand adults with a previous or journalist told me of a recorded interview mental health and suicide were published existing mental health problem said they with someone recovering from a brain in 2008 by the Department of Health in thought the media as a whole portrayed injury, which was removed from the the form of a media handbook called mental health in a sensitive way. programme at the last minute. His clinical

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‘What’s the Story?’. It urged journalists to report fairly and accurately, to use quotes from people with mental health issues and to give out numbers of helplines like the Samaritans. The journalists’ union, the NUJ, has issued something similar. However, much more can be done.

Broadcast organisations would do well to create their own training schemes and provide instant resources. Guidelines for news reporters and producers could emphasise the importance of the use of language in mental health issues, including suggestions on how to help the participant create and shape the interview and information on the potential pitfalls, arising from the editing process. Recently, the BBC agreed to make a video for its training website, highlighting the most common errors. I’d urge media companies to do similar and go further. Increased education and scientific literacy, with training in mental health matters and instant access to the tools and resources needed to understand problems and conditions, can reduce stigma, as the Australian model shows.

The interviewer could discuss the structure and tone of the conversation with the interviewee before the recording, to clarify how best to allow them to tell their experience. Transparency is vital if the interviewee is to feel comfortable and represent themselves as effectively as possible.

During the research process, broadcasters could speak to charities that represent those considered vulnerable; to make sure the right language is used.

In its 2013 guidelines for documentary producers, Mind suggests meeting mental health groups, listening to different voices and reading blogs by those with mental health problems. Mind also recommends giving the contributor clear ideas of question areas, reminding them they can withdraw at any time, telling them honestly about the editing process, and, if their contribution is dropped, explaining why.

Even if guidance has been given, training taken and all ethical practises considered, there’s another vulnerable voice that many journalists need to consider and protect – their own.

Sometimes, news crew run to a story with a tape recorder or camera, but are ill prepared for what they experience when they arrive. Whether it’s a war zone, disaster area or reporting from a court case with graphic and upsetting evidence,

Journalists’ checklist I Can the guest give informed consent and do they fully understand the interview process?

I Is their support team aware of their contribution?

I Have you contacted charities or organisations to get help and information about the issue under discussion?

I Have you asked the guest what they would like or expect from the interview?

I Have you reassured them about content, duration and publication date?

I Have you ensured they are seen as a person, not a diagnosis?

I Are you using the right language and terminology?

I Should you provide a helpline number after the interview?

I Have you considered your own mental health, and sought support if necessary?

the adrenalin and the pressure of a deadline kick in and any uncomfortable thoughts are pushed to the back of the mind to be dealt with later, if at all.

Vulnerability on both sides After a week reporting from Pakistan from the epicentre of the earthquake in 2005, I remember returning to a comfortable hotel in Islamabad, taking off my boots and frantically scrubbing them, again and again. Even when the detritus had gone, I kept washing them. When I returned home to the warmth of my family, images of devastation and decay, the cries of distress and the sickly smell of disease and death lingered.

As always, news crew are witnesses to horrors others live through. We can leave, they can’t. The suffering of those left behind in such events is immeasurably worse than anything reporters can experience, so it feels self-indulgent to acknowledge any difficult emotions. Yet sometimes, you just can’t shake them off.

Various research findings suggest that post-traumatic stress disorder symptoms in reporters covering traumatic events range from around 6 per cent to 28 per cent, with war correspondents experiencing levels similar to combat veterans.

Despite that, some news crew still believe it’s a sign of weakness to seek

help, that there’s a stigma attached to admitting distress. But that attitude may be changing. Broadcast organisations have begun to develop peer support trauma networks – I’m one of a team trained to assess colleagues who have returned from difficult and challenging environments.

Other resources, like those offered by the DART Center for Journalism and Trauma (see www.dartcenter.org), provide guidance on how news crew can report on trauma responsibly, while also protecting their own mental health.

The challenge is getting that awareness directly into newsrooms and embedding it into the culture. Journalists need to feel they have the skills and training to fairly represent those caught up in challenging events, or those who are experiencing mental health issues, while also feeling confident that they have the understanding and resilience to protect themselves. Perhaps there will always be a conflict between the needs of the broadcaster and those caught up in the news, but the media can be better prepared to make it a rewarding experience for both, and an enlightening and engaging one for the audience.

I Sian will be speaking at the Society’s Annual Conference gala dinner, at the Crowne Plaza Hotel in Birmingham, on 8 May. To book, see www.bps.org.uk/ac2014

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CAREERS

A rollercoaster ride Ian Florance talks to Claudia Hammond about how she has put her background in academic psychology to good use in her broadcasting career

interviewed Claudia Hammond in a London café on the day before the first episode of her new BBC Radio 4 series was broadcast. State of Mind tells the story of mental health care in the UK from the 1950s to the present. Many readers will

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know her regular programme All in the Mind, perhaps the most important source of psychological ideas in the UK media.

Early on in the interview the café fuse box blew. Struggling to scribble notes in the gloom increased the anxiety of interviewing someone quoted on the BBC Radio 4 website as saying: ‘The great thing about this job is getting to interview some of the most brilliant researchers in the world...’ and who commented: ‘It’s a really luxury to be able to decide what I want to ask them.’

So, how did Claudia become one of the most listened to and read UK psychologists after a period as a greyhound tipster? And why does she tend to be seated next to new-age enthusiasts at weddings?

I asked her what came first – psychology or the media. ‘I was at a children’s book festival and, after I had queued up to get Roald Dahl’s autograph, he asked me what I wanted to do when I grew up. I’m told I said “I want to work in radio”. That was the first

my parents knew about it. It was probably the first time I realised.’

It seems radio work was the constant.

Claudia worked local stations in parallel to and between school and university. Her interest in psychology developed out of that. ‘Claudia’s Sunday Requests on Hospital Radio Bedford was not an awardwinning production’, she says (though Claudia is still listed on their website). ‘I started it when I was 14. I went round the wards asking for requests and I found myself going in earlier and staying longer.

Patients told me their stories and details of their illnesses and treatments. This was what got me interested in psychology, maybe what even led to me doing a postgraduate degree in health psychology.’

Not that this educational path was a foregone conclusion. ‘Before going to Sussex to do a degree in applied psychology I worked at Three Counties Radio as a newsroom assistant. Watching news stories come in and going in and out of the studios during live programmes was incredibly exciting. Occasionally I’d get on air too: the first time was giving blood on the breakfast programme. So I can say I’ve given blood for the BBC! I thought about staying on but was convinced I should get a degree. My friends thought I’d do media studies, but I wanted to learn about something new. So I did a degree in applied psychology at Sussex.’

Claudia’s book Emotional Rollercoaster displays her fascination with research findings. This started during her first degree. ‘I liked the experimental aspect of the work – setting up a hypothesis then testing it. I also found I liked the range of psychology – the number of different areas it studies and affects, the different ways of doing it. I knew I didn’t want to be a clinical psychologist, although I did think about going into research. But at the time I was also

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careers

working at Radio Sussex so I was torn between psychology and radio.’

Claudia undertook an MSc in health psychology at Surrey University, researching doctor–patient communication in a breast cancer unit.

Her first job on national radio – as a journalist on Radio Five Live – marked a real change. ‘I’d done the greyhound racing tips on local radio, but now I was dealing with sports stories as well as breaking news. I’m hardly an expert on sport. This, along with watching a piece on horse insemination involving recording people doing extraordinary things with drainpipes, are two of my odder media experiences.’

Claudia stressed that she’s always been and remains freelance rather than a staff member. ‘In a sense I was trying to keep parallel careers going, as a reporter on the one hand and as a psychology lecturer on the other.’ But whatever strange tasks she undertook as a journalist, she was always looking to develop items on psychology and wider health issues. ‘I began to start reporting on Radio 4 series such as Woman’s Hour and All in the Mind.’

Claudia was then able to bring the two together, presenting a wide range of programmes that reflect her earlier fascination with psychology’s breadth: it covers memory, group psychology, positive psychology, conformity and sports psychology, among many other subjects. There’s also a strand that looks at wider health and biological science issues: fingerprints, the experience of miscarriage. ‘I have a weekly programme Health Check on the BBC World Service.

This has led to some extraordinary experiences and gives me a chance to get a more global view of health provision.

Visiting the biggest brothel in the world was quite extraordinary.’ (You can read her fascinating Guardian article on this at tinyurl.com/da49oq).

Claudia also has a regular column in Psychologies, originally a French magazine but now available in a number of European editions. She describes it as a ‘women’s glossy monthly magazine that’s different from any other, because there’s no fashion’. Her first book, on the science of emotions, was published in 2005 to excellent reviews.

She chairs conferences and lectures too. ‘I started at the OU and now lecture on two courses – Social Psychology Issues in the UK and Health Psychology for Boston University’s UK base. I love doing this. Students challenge you and expose you to different views and I like having to keep up to date for those lectures.’

Claudia must also surely be the only psychologist to appear alongside bands,

comedians, novelists and poets at the Latitude Festival in 2008.

In the gathering gloom of the London café it was sometimes difficult to keep up with the sheer range of Claudia’s activities. What is the common thread running through them?

‘Sometimes if I go to a wedding I’m put next to someone who is “interested in psychology”. Quite often, this person turns out to want to talk about chakras, read my aura, compare crystals or some other new-age topic. People are fascinated with psychology but they don’t always understand what academic psychology covers. They link it to fringe beliefs and activities. There can be a misunderstanding among people who set out to study psychology. Sometimes they think it will help them work through their problems.’

In an interview included in her book, Claudia expanded on this. ‘It’s not a selfhelp subject… for the most part psychology today is about the study of large numbers of people; it’s not about introspection.’

So Claudia says she is trying to ‘give people a better understanding of the role psychology plays. Helping people articulate and get across a seemingly technical piece of good research is central to my approach. I also like bringing different specialists together – it’s amazing how often people who are hugely expert in one area of psychology know next to nothing about related work in a slightly different field. I really enjoy it when two people involved in a discussion exchange cards on the way to the lift and decide they might do some work together. One suggested I set up a matchmaking service for academics!’

You’ve met some very well-known psychologists. Do they intimidate you? ‘I interviewed Philip Zimbardo in his house and he cooked pizza for us. It’s a privilege to meet and listen to such people. But, the advantage is that I’ve got a role, an excuse for being there as an interviewer for the BBC - and I’ve done my homework. So I’m not frightened. I like to be in control, so that I don’t get in the way and you hear the ideas from the horse’s mouth. Reading journal articles is one thing, but hearing someone actually talk about their research can really bring it to life.

‘I can’t emphasise too much how my experience as a reporter and producer in my early media career has helped me.

Understanding how the media works as well as knowing your subject is crucial.

But it’s more than that. The experience of working in a local radio newsroom and at 5Live taught me about balance and

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fairness in discussions, something that’s crucial even in non-news programme like All in the Mind. My personal opinions are irrelevant when it comes to a programme like that – it’s all about letting everyone have a fair say and critically questioning their research and viewpoints.’

This led us on to Claudia’s advice for psychologists seeking too communicate their ideas. Here are her key points.

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Be choosy: don’t accept everything.

Popular programmes are fine – ‘I sometimes go on Richard & Judy to talk about psychological research – but if I think a show is going to dumb it down, I say no. And sometimes they’re looking for is a qualified therapist, and that’s not me.’

Ask plenty of questions beforehand on the phone (not when you arrive at the studio), so that you can think about what you’re going to say.

Don’t agree to talk about subjects you know nothing about. Have some research in mind that backs up what you’re saying, but be realistic about how detailed you can be – this isn’t the place for a critique of research methods and stats.

If you choose the programme well, the interviewer and interviewee are in it together. The interviewer wants to make the interviewee look good because its makes a better programme.

Psychology is something worth talking about. ‘It’s a pity when good researchers are nervous about getting their research out there where the public can hear about it. There’s such an appetite for psychology amongst the public that it would be great to see some really good TV programmes made on the subject.’

In near pitch blackness I asked Claudia what her plans were for future programmes, series and books. I was aware that this might be asking her to give too much away about submissions to the BBC or her publishers and she thought long and hard about it. The next day I received an e-mail which is worth quoting: ‘What I hope might happen in the future is that just as the field of economics is suddenly catching on to the decades of psychological research on decision-making, that other fields might start to do the same and to realise that there’s all this research out there which could be put into practice. Expert panels and commissions wouldn’t dream of not including an economist. I’d like to see a day when they all have a psychologist too.’

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ARTICLE

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the everyday given the right conditions?

Is mirror-writing after brain damage a recurrence of the childhood form, or different? More than a century of sporadic scientific literature, and some of our own recent observations, suggest answers to these tantalising questions.

Mirror-writing Robert D. McIntosh and Sergio Della Sala explore some intriguing phenomena

questions

Mirror-writing is the production of letters, words or sentences in reverse direction, so that they look normal when viewed in a mirror.

Some people may mirror-write intentionally; but unintentional mirror-writing is surprisingly common amongst young children, and in brain-damaged adults.

Unintentional mirror-writing suggests a tension between a tendency for our brains to treat mirror-images as equivalent, and a culturally imposed need to distinguish between them for written language. This article explores the various manifestations of mirror-writing, and the ideas put forward to account for it.

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Is mirror writing a perceptual or a motor phenomenon? Is it the same phenomenon in young children as in brain-damaged adults?

resources

Schott, G.D. (2007) Mirror writing: neurological reflections on an unusual phenomenon. Journal of Neurology, Neurosurgery & Psychiatry, 78, 5–13.

Della Sala, S. & Cubelli, R. (2007).

‘Directional apraxia’: A unitary account of mirror writing following brain injury or as found in normal young children. Journal of Neuropsychology, 1, 3–26.

references

Why would it be useful for our brains to treat mirror-image objects and actions as equivalent?

Allen, F.J. (1896). Mirror-writing. Brain, 19, 385–387.

Angelillo, V.G., De Lucia, N., Trojano, L., & Grossi, D. (2010). Persistent left unilateral mirror writing. Brain and Language, 114, 157–163.

Balfour, S., Borthwick, S., Cubelli, R. & Della Sala, S. (2007). Mirror writing and reversing single letters in stroke patients and normal elderly. Journal of Neurology, 254, 436–441.

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icture yourself in a taxi on a cold, rainy day, condensation on the windows. You want to write ‘byebye’ to your daughter waving at you from the house. In order to be read by her, you would need to write in reverse on the inside of the window, transforming your habitual writing actions to do so. This is ‘mirror-writing’ – reversed writing that looks normal when viewed in a mirror; like the sign on the front of an ambulance.

Since Western scripts typically run from left to right, this reversed form is also known as levography (Critchley, 1928) or sinistrad writing (Streifler & Hofman, 1976).

Mirror-writing is striking and mysterious. It has been practised deliberately by some notable individuals, most famously Leonardo da Vinci, and portrayed to powerful effect in literature and visual art (see Box, right). Mirrorwriting is of special interest to psychologists because it can sometimes arise in people trying to write normally.

For example, unusual writing demands can sometimes mislead us into writing backwards. If we write onto paper pressed against the underside of a table, or against our forehead (Critchley, 1928), we may fail to transform our actions to compensate for the altered plane of performance, and our writing may come out mirror-reversed.

Mirror-writing is also common amongst children learning to write, and is noted in adults following brain damage, usually to the left hemisphere.

But what do these phenomena tell us about our brains? Do we each harbour a latent looking-glass world, poised to usurp

Chan, J.L. & Ross, E. (1988). Left-handed mirror writing following right anterior cerebral artery infarction.

Neurology, 38, 59–63.

Cornell, J.M. (1985). Spontaneous mirror-writing in children. Canadian Journal of Psychology, 39, 174–179.

Critchley, M. (1928). Mirror-writing.

London: Kegan Paul, Trench, Trubner & Co. Cubelli, R. & Della Sala, S. (2009). Mirror

Explanations of mirror-writing Does mirror-writing imply reversed perceptions, or is it only that the action comes out backward? This captures the dichotomy between perceptual and motor explanations of mirror-writing, from the classical literature to the present day. On the perceptual side, Orton (1928) suggested that, for every word or object we recognise, an engram is stored in the dominant (left) hemisphere, and its mirror-image in the non-dominant hemisphere. Mirrored-forms emerge in children, due to incompletely established hemispheric dominance, but are suppressed in adults unless released by left-hemisphere damage. Subsequent perceptual accounts, such as the spatial disorientation hypothesis (Heilman et al., 1980), share the core idea that mirrorwriting is one aspect of a more general mirror-confusion. Perceptual explanations predict that mirror-writing should be associated with perceptual confusion, and even with fluent reading of reversed text.

And if the mirroring arises at a perceptual level, then mirror-writing should emerge regardless of which hand is used.

On the motor side are those who argue that action representations are critical to mirror-writing (e.g. Chan & Ross, 1988; Erlenmeyer, 1879, cited in Critchley, 1928). The basic insight is that learned actions are represented in a body-relative scheme, not in external spatial coordinates.

Thus, for a right-handed Westerner, the habitual writing direction is not left-toright per se, but abductively outwards from the body midline. If executed by the unaccustomed left hand, this abductive action will flow right-to-left, unless it is transformed into an adductive inward action, much as we need to transform our

writing in pre-school children.

Cognitive Processing, 10, 101–104.

Davidoff, J. & Warrington, E.K. (2001). A particular difficulty in discriminating between mirror images.

Neuropsychologia, 39, 1022–1036.

Dehaene, S., Nakamura, K., Jobert, A. et al. (2010). Why do children make mirror errors in reading?

Neuroimage, 49, 1837–1848.

Della Sala, S. & Cubelli, R. (2007).

‘Directional apraxia’: A unitary account of mirror writing following brain injury or as found in normal young children. Journal of Neuropsychology, 1, 3–26.

Della Sala, S., & Cubelli, R. (2009).

Writing about mirror writing. Cortex, 45, 791–792.

Durwen, H.F. & Linke, D.B. (1988).

Temporary mirror writing and mirror reading as disinhibition phenomena?

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Examples in literature and film ‘And how was the anonymous letter written?’

‘Backhanded.’ Again the abbe smiled. ‘Disguised.’

‘It was very boldly written, if disguised.’

The Count of Montecristo by Alexandre Dumas père He wrote, Dear Henry Phipps, in a violet-coloured ink. He did not write these words from left to right, but thus: sppihP yrneH raeD He wrote fluidly, as if long accustomed to that distrustful art. …The Thief-taker has given you the mirror.

Jack Maggs, a novel by Peter Carey Since the occurrences we are about to consider (as impartially as possible), he has found the utmost difficulty in writing except from right to left across the paper with his left hand.

The Plattner Story, a novel by H.G. Wells WARNER BROS / THE KOBAL COLLECTION

action when writing on a window for a reader on the other side. On this view, children might mirror-write with either hand if they have yet to learn a consistent direction, but literate adults should do so only when attempting to write with the left hand whilst cognitively impaired or distracted, so that the required transformation is omitted. Since perceptual factors play no explanatory role, motor accounts predict that mirror-writing should not entail perceptual confusions or mirrorreading.

Of course, perceptual and motor accounts need not be mutually exclusive: the manifestations of mirrorwriting may be too various for any unitary account (Critchley, 1928; but see Della Sala & Cubelli, 2007). As we shall see, the facts favour a motor interpretation in most cases; but there are possible exceptions, and interesting nuances to the story, as well as some unresolved puzzles.

Spontaneous mirror-writing in children As any nursery or primary teacher knows, mirror-writing is very common amongst children learning to write.

These productions are not mere confusions of legal mirror-image characters (such as ‘b’ and ‘d’) but can involve the reversal of any character, and even whole words and phrases. A child may sign her name neatly but back-tofront. Interestingly, some characters are more likely to be reversed than others, particularly those such as ‘3’ or ‘J’ in which the correct form ‘faces’ leftwards.

This suggests that during exposure to written language, the child implicitly extracts the statistical regularity that most characters ‘face’ to the right, then overapplies this ‘right-writing rule’ (Fischer, 2011).

Several myths surrounding mirrorwriting in children should be dispelled.

Most prominent is the traditionally assumed association with slow intellectual

A case study. Neuropsychologia, 26, 483–490.

Fischer, J-P. (2011). Mirror writing of digits and (capital) letters in the typically developing child. Cortex, 47, 759–762.

Fischer, J-P. & Tazouti, Y. (2011).

Unraveling the mystery of mirror writing in typically developing children. Journal of Educational Psychology. doi: 10.1037/a0025735

Danny writing on the door in The Shining

development, arising from early anecdotal literature (e.g. Orton, 1928) and studies of ‘mentally defective’ children (Gordon, 1920), and propounded as a visual motif through popular works (e.g. Winnie-thePooh, the Far Side cartoons). Recent studies have converged in showing that the likelihood of mirror writing does not correlate with intellectual abilities. Cubelli and Della Sala (2009), for instance, reported no significant difference in intelligence between mirror-writing and non-mirror-writing children of the same age (cf. Fischer & Tazouti, 2011). There is similarly little truth in the idea that mirrorwriting is more common in left-handers.

Mirror-writing in childhood does of course correlate with age, but the true underlying

Gordon, H. (1920). Left-handedness and mirror-writing especially among defective children. Brain, 43, 313–368.

Gottfried, J.A., Sancar, F. & Chatterjee, A. (2003). Acquired mirror writing and reading: Evidence for reflected graphemic representations.

Neuropsychologia, 41, 96–107.

Heilman, K.M., Howell, G., Valenstein, E. & Rothi, L. (1980). Mirror-reading and writing in association with right-

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Mirror-writing has also been portrayed in films: in Christopher Nolan’s Memento, the ‘facts’ are tattooed on Leonard's chest in mirror-writing so that he can read their reflection; in Stanley Kubrik’s The Shining, Danny writes REDRUM on the door, which is MURDER backwards (Maggie does the same with her toy blocks in the Simpsons episode Reality Bites). Mirror-writing also features in the Simpsons episode ‘Brother from the same planet’; the Scooby-Doo episode ‘Mystery mask mix-up’; The 25th Hour; Alvin and the Chipmunks; and Flowers for Algernon. For further examples, see Della Sala and Cubelli (2009).

factor here is the stage of acquisition of writing, with occasional mirror-writing as an intermediate stage between no writing and correct writing (Della Sala & Cubelli, 2009; Fischer & Tazouti, 2011).

Situational factors further modulate the likelihood of mirror-writing at any given moment. For instance, children show sequential biases, tending to face each character in the same direction as the preceding one. An example from Fischer (2011) concerns the character pair ‘C3’, as written by 300 five-to-six-year old children: the probability of mirror-writing the ‘3’ was far greater (0.73 vs. 0.10) if the ‘C’ had been correctly written (i.e. rightfacing) than if it had been mirror-written (i.e. left-facing). Spatial constraints are also

left spatial disorientation. Journal of Neurology, Neurosurgery and Psychiatry, 43, 774–780.

Lambon-Ralph, M., Jarvis, C. & Ellis, A. (1997). Life in a mirrored world: Report of a case showing mirror reversal in reading and writing and for non-verbal materials. Neurocase, 3, 249–258.

Orton, S.T. (1928). Specific reading disability – strephosymbolia. Journal

of the American Medical Association, 90, 1095–1099.

Parsons, L.M. (1987). Imagined spatial transformations of one’s hands and feet. Cognitive Psychology, 19, 178–241.

Parsons, L.M. (1994). Temporal and kinematic properties of motor behavior reflected in mentally simulated action. Journal of Experimental Psychology: Human

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important, and children as old as seven may write their name backwards if required to start from a point on the page that leaves inadequate space to write it forwards (Cornell, 1985; Fischer & Tazouti, 2011). That a simple spatial restriction can elicit mirrored script suggests a dominant role for motor factors, rather than perceptual confusion.

Consistent with this, Della Sala and Cubelli (2009) found that the frequency of mirror-writing was no higher amongst children who had difficulty discriminating mirror images than amongst those who did not. Uncertainty about how letters should look does not seem to drive mirror-writing in children.

Rather, childhood mirror-writing may tell us something about how writing actions develop. Specifically, it implies that the general shape of a letter is learned more rapidly than the direction for writing it. The key to understanding this may be to regard mirror-writing not as intrinsically errorful, but as a feat of action generalisation. It is a neat trick for a child to produce a perfect mirrored-form, which they have never been taught, as readily as the correct form that they have been shown repeatedly. For most actions, this mirror-generalisation would be useful, because anything that we do one way may need to be done in reverse at another time; we do not learn separately to turn a tap clockwise and anticlockwise, only to turn the tap. Writing, however, belongs to an unusual, evolutionarily recent, class of actions that have a culturally set directionality, and for which this generalisation is unhelpful. Acquiring the correct direction for writing in one’s culture may be a matter of stamping out the unwanted alternative after having learned the general shape of the action.

Involuntary mirror-writing after brain damage Children grow out of mirror writing, but in some adults it makes an unexpected return. Mirror-writing is quite common following stroke, though usually

Perception and Performance, 20, 241–245.

Pegado, F., Nakamura, K., Cohen, L. & Dehaene, S. (2011). Breaking the symmetry: Mirror discrimination for single letters but not for pictures in the Visual Word Form Area.

Neuroimage, 55, 742–749.

Pflugshaupt, T., Nyffeler, T., von Wartburg, R. et al (2007). When left becomes right and vice versa:

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transient. Frequency estimates vary from 2.5 per cent (Gottfried et al., 2003) to 13 per cent (Tashiro et al., 1987), but are much higher (24 per cent) if only left hemisphere lesions are considered (Wang, 1992).

A review of single cases confirmed that mirror-writing following stroke is overwhelmingly associated with damage to the left hemisphere (93 per cent) and with use of the non-dominant left hand (97 per cent) (Balfour et al., 2007).

The prototypical adult mirror-writer is a right-hander who loses right-arm motor function following left-hemisphere stroke, being forced to write with the left hand.

Given this profile, could the strong association of mirror-writing with lefthemisphere damage be an artefact of forced left-hand use? Would mirror-writing be elicited in other groups simply by requesting writing with the left hand?

When this tactic was tried, it yielded mirror-writing rates that did not differ statistically between right- and lefthemisphere damaged people (14 per cent of 36 cases vs. 20 per cent of 50 cases) (Balfour et al., 2007). Even amongst 86 healthy controls, writing with the left hand produced at least some reversals in 7 per cent of people; but writing with the right hand never did.

These results fit the motor hypothesis, according to which involuntary mirrorwriting in adults reflects left-handed execution of a right-hand action, without motor transformation. The transformation requires cognitive resources, so would be susceptible to attentional lapses, and especially vulnerable after brain damage.

Mirrored vision after cerebral hypoxia. Neuropsychologia, 45, 2078–2091.

Russell, J.W. (1900). A case of mirror writing. Birmingham Medical Review, 68, 95–100.

Streifler, M. & Hofman, S. (1976).

Sinistrad mirror writing and reading after brain concussion in a bisystemic (oriento-occidental) polyglot. Cortex, 12, 356–364.

We must stress that the sporadic reversals obtained by asking brain-damaged people to write with the left hand are of a different order of severity from florid clinical cases, which may involve consistent reversal of words, multi-digit numbers and sentences (see Della Sala & Cubelli, 2007). To fully account for severe and persistent mirrorwriting may require more pervasive cognitive insufficiencies, perhaps combined with anosognosia (lack of insight) or anosodiaphoria (lack of concern) (e.g. Angelillo et al., 2010).

So, children may mirror-write because they are unsure of the correct direction, whilst adults retain the correct (abductive) direction, but fail to modify this motor habit for the unaccustomed hand.

However, an alternative motor account, which relates involuntary mirror-writing more closely to the childhood form, has been advanced by Della Sala and Cubelli (2007). This ‘directional apraxia’ hypothesis proposes that involuntary mirror-writing reflects loss of knowledge of the direction of learned actions, with execution instead governed by a preference

Tashiro, K., Matsumoto, A., Hamada, T. & Moriwaka, F. (1987). The aetiology of mirror writing: A new hypothesis.

Journal of Neurology, Neurosurgery and Psychiatry, 50, 1572–1578.

Turnbull, O.H. & McCarthy, R.A. (1996).

Failure to discriminate between mirror-image objects: A case of viewpoint-independent object recognition? Neurocase, 2, 63–72.

Wade, J., & Hart, R. (1991). Mirror

phenomena in language and nonverbal activities: A case report.

Journal of Clinical and Experimental Neuropsychology, 13, 299–308.

Wang, X-de (1992). Mirror writing of Chinese characters in children and neurological patients. Chinese Medical Journal, 105, 306–311.

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for abductive movements. This implies that the direction of an action is not only acquired later than its shape, but represented separately, and vulnerable separately to damage. It is not clear whether this account improves on the standard motor account in explaining documented cases of mirror-writing, but further data on the influence of language and handedness may prove decisive.

Directional apraxia predicts that mirrorwriting should affect the left hand for rightward scripts such as English, but the right hand for leftward scripts such as Hebrew or Arabic, regardless of the writer’s handedness. There is one report, which fits this prediction exactly, of a man who mirror-wrote in Hebrew but not in French with his right hand, yet produced the opposite pattern – mirror writing in French but not in Hebrew – with his left hand. However, the observation is anecdotal (Marinesco, cited by Russell, 1900), and requires replication.

The role of mirror-perceptions Mirror-writing does not entail an advantage for reading mirrored text; a fact that considerably bolsters a motor account (Critchley, 1928). But analogous phenomena can affect perception. Parietal lobe damage can induce an inability to tell apart mirror-images, even though subtle changes in shape or rotation are spotted (Davidoff & Warrington, 2001; Turnbull & McCarthy, 1996). Such mirror-confusions sometimes co-occur with mirror-writing (Durwen & Linke, 1988; Heilman et al., 1980; Wade & Hart, 1991). In other cases, perception may be

systematically reversed, yielding fluent mirrorreading (Gottfried et al., 2003; Lambon-Ralph et al., 1997; Pflugshaupt et al., 2007). If these people also mirrorwrite, it may be deliberate, and some state that they do so in order to be able to read what they write.

However, the most unusual report is of a polyglot woman who, following a concussion, mirror-read and wrote her first language, Hebrew (a right–left script), but not Polish or German (left–right scripts) (Streifler & Hofman, 1976). Her mirror-writing was apparently involuntary, affecting the dominant right hand (the left hand was not tested); and she displayed a range of other reversals, perceptual and conceptual (confusion of opposites like inside/outside, above/beneath).

The language-specificity of her mirrorreversals is challenging to explain, but the tight parallel between her reading and writing suggests that involuntary mirror-writing can have a perceptual (or conceptual) basis in some cases.

Like mirror-writing, acquired mirrorreading recalls the errors of childhood; and, as for writing, perceptual confusions in children may reflect a broadly advantageous mirror-generalisation. In nature, mirror-images are invariably two instances or views of the same thing, so it is efficient to represent them as equivalent.

On the other hand, we sometimes need to distinguish mirror-forms, and nowhere is this more vital than in decoding written language. Functional neuroimaging suggests that a region of the left midfusiform gyrus (the ‘visual word form area’) may be critical to mirrordiscrimination in reading (Dehaene et al., 2010; Pegado et al., 2011). The development of this capacity presumably suppresses mirror-reading errors during learning.

Deliberate mirror-writing

Writing in Brain in 1896, F. J. Allen, a neurologically healthy Professor of Physiology, recorded his subjective

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experience of fluent left-handed mirrorwriting, speculating that the ability may not be rare, just rarely practised. He proposed that ‘mirror-writing is often a symptom of nerve disease; but the disease need not be the cause of the existence of the faculty, but only the cause of its discovery’ (p.385). As already noted, mirror-writing is adopted deliberately by some brain-damaged people with reversed perceptions. It is also cultivated by some healthy, albeit unusual, people; often to a high level of skill. Celebrated practitioners include Lewis Carroll, who experimented with spatial as well as logical inversions, and was a skilled mirror-writer. Amongst the 100,000 letters that he wrote were a series of ‘looking glass letters, designed to be read in a mirror. Mirror-writing also appears in his stories and poems. In Through the Looking-Glass one of Alice’s first discoveries is a book printed in mirrorscript. There was also Leonardo da Vinci, who wrote thousands of pages of his notebooks in mirrored script, with his left hand. Could deliberate mirror-writing offer insight into the nature of involuntary mirror-writing in braindamaged adults?

We have recently had the chance to address this issue with Kasimir Bordihn (KB), a German artist, who has practised various forms of mirror-writing for more than 50 years. KB is a natural left-hander, schooled to write with the right hand, who ‘discovered’ mirror-writing aged nine, finding that he could halve his time writing lines by writing forward with his right hand and simultaneously backward with his left. He later practised and extended this technique, writing forward or backward with either hand, including vertical as well as horizontal flips, and incorporating these into a distinctive ‘mirror-art’ (see cover). We have begun a case study of KB’s abilities, which is providing clear support for the motor hypothesis of mirror-writing, and some less expected results.

First, whilst KB writes skilfully in a number of different directions, his most fluent form, and the only non-standard form that closely resembles his normal forward right-handed script, is horizontal mirror-writing produced with his left hand.

This special status is consistent with the view that left-handed mirror-writing reflects the untransformed execution of a learned right-hand action. Second, when writing with both hands, his performance is far better if his hands move mirrorsymmetrically to produce opposite scripts, than if they move in tandem to produce similar scripts. It is the motor and not the perceptual congruence that counts. Third,

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as with most involuntary mirror-writers, KB’s versatility with a pen confers no perceptual benefit: he is as baffled by mirrored text as any other reader. These characteristics match a motor account of mirror-writing.

As well as asking KB to read mirrored text out loud, we assessed his recognition of reflected letters by psychophysical means, finding nothing unusual. But when instead we asked KB to discriminate pictures of left and right hands, he showed a consistent inability, performing dramatically worse than matched controls, and on one occasion faring no better than chance. This was not a general problem with body parts, as he could discriminate the laterality of feet very well; and it was not due to rushed decision making, as his hand discriminations were both slow and inaccurate. Rather, KB revealed a specific impairment for the discrimination of left and right hands.

This body-part identification task is used widely as a test of motor imagery.

People solve this task by mentally rotating their own hands or feet to confirm a match to the viewed picture (Parsons, 1987, 1994). One possible interpretation of KB’s result is that his unusual facility for

(and/or history of) executing right-hand actions with the left may entail an abnormal degree of overlap in the neural motor representations of the hands. He may thus rotate his hands mentally to match the picture, yet fail to identify introspectively which hand has made the match. This is a highly preliminary suggestion, but the observation is certainly intriguing. One more flippant implication might be that Leonardo da Vinci, for all of his genius, may have had more trouble than the average Renaissance man in telling his left hand from his right.

Final reflections As children, we make mirror-errors in reading and writing. These perceptual and

motor confusions are not tightly linked, but arise from parallel strategies of mirror-generalisation in perception and action. If we then learn to write with our right hand, mirror-writing may be the latent natural script of our left, and viceversa, requiring only certain circumstances to emerge.

Mirror-writing in its various forms – spontaneous, involuntary and deliberate – has long fascinated observers in art and science. Beyond its obvious curiosity value, it provides compelling insights into how we learn about, and represent the world and our actions within it.

The story is intriguing, yet incomplete.

We think there will be more to learn about ourselves in this particular lookingglass.

Robert D. McIntosh is at Human Cognitive Neuroscience, Psychology, University of Edinburgh r.d.mcintosh@ed.ac.uk

Sergio Della Sala is at Human Cognitive Neuroscience, Psychology, University of Edinburgh sergio@ed.ac.uk

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Research. Digested.

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Understanding amnesia – Is it time to forget HM? 55 years since the famous amnesic’s case was first described, John P. Aggleton questions its value when debating the neuroanatomical basis of memory

he amnesic HM is the most famous single-case in neuropsychology, and possibly the best known case in all of psychology. Over one hundred studies have been published involving HM, and when he died in 2008 it was worldwide news. Interest in Henry Molaison (as we then discovered) was so high that when his brain was sectioned the procedure was filmed for the internet, prompting, among other things, a stage play. Ironically, HM always remained unaware of his fame (Corkin, 2002). The question posed here is whether it is time for us to reciprocate – should we forget HM? Almost every introduction into the neural basis of memory describes how in 1953 the surgeon William Scoville removed tissue in both medial temporal lobes of HM’s brain in an attempt to treat his epilepsy. Immediately thereafter, HM displayed severe anterograde amnesia – a failure to retain new day-to-day events – which remained throughout the rest of his life. This catastrophic outcome ensured that HM’s surgery was not repeated, so making him unique.

As has been often described, HM showed preserved IQ despite his loss of long-term memory. He also showed preserved short-term memory (e.g. immediate memory span) and a good knowledge of past factual information. (episodic memory). Subsequent research revealed his spared ability to learn new perceptual-motor skills, e.g. mirror drawing (Corkin, 2002), discoveries that helped to establish emerging distinctions

references

T

612

Aggleton, J.P. & Brown, M.W. (1999).

Episodic memory, amnesia and the hippocampal anterior thalamic axis.

Behavioral and Brain Sciences, 22, 425–466.

Bachevalier, J., Parkinson, J.K. & Mishkin, M. (1985). Visual recognition in monkeys: Effects of separate vs. combined transection of the fornix and amygdalofugal pathways.

Experimental Brain Research, 57,

between explicit and implicit learning.

Much of the impact of HM arises, however, from Scoville’s surgery and how that inadvertently established the importance of the hippocampus for learning and memory.

Given this impact it seems churlish to question the legacy of HM Indeed, it must be made clear that this article is not a criticism of research on HM (which has consistently been of an exceptional level and deservedly praised); rather it concerns how key elements of this hugely influential body of research have been more generally interpreted and reported.

Does hippocampal pathology cause anterograde amnesia?

The Russian neurologist Bekhterev is often credited as the first person to signal the involvement of the hippocampus in memory. Bekhterev’s research was, however, suppressed after his death, quite probably on the orders of Stalin who may have had Bekhterev killed (Lerner et al., 2005). It is, however, indisputable that Scoville and Milner (1957) drew new attention to the importance of the hippocampal formation for long-term memory, and did so in a way that profoundly altered neuroscience.

It is because HM is regarded as unique that his case has had such influence, yet in their landmark paper, Scoville and Milner (1957) described eight cases in addition to HM who received bilateral removal of tissue in the medial temporal

554–561.

Brown, M.W., Warburton, E.C. & Aggleton, J.P. (2010). Recognition memory: Material, processes, and substrates. Hippocampus, 20, 1228–1244.

Corkin, S. (2002). What’s new with the amnesic patient H.M.? Nature Reviews Neuroscience, 3, 153–160.

Corkin, S., Amaral, D.G., Gonzalez, R.G. et al. (1997). H.M.’s medial temporal

lobes. Along with HM, one other case had the most ‘radical’ surgery, intended to remove the full extent of the hippocampus. In six of the remaining cases the surgery was more restricted as it was intended to reach only the front of the hippocampus or only midway through the structure. Within this group of patients, HM was unique as his was the only surgery for the relief of epilepsy. The other patients received psychosurgical treatments intended to relieve schizophrenia (n = 7) or bipolar depression (n = 1). The failure of Scoville’s surgeries to reduce these psychiatric symptoms inevitably posed problems for their cognitive assessments, and the formal testing of three of these schizophrenic cases was incomplete.

Added problems would have arisen from the fact that schizophrenia is itself associated with appreciable memory loss.

Despite these issues, several features of the original study on HM seem to create a compelling case for the importance of the hippocampus. Most critically, comparisons among all nine patients revealed that severe memory deficits were only seen after radical resections involving most of the hippocampus. Unfortunately, the real extent of the surgeries could only be subsequently determined for HM, for whom there is structural MRI data (Corkin et al., 1997). We are, therefore, reliant on Scoville’s surgical notes for the other eight patients. In fact, we now know that Scoville failed to remove the caudal 2cm of HM’s hippocampus, despite his intention to do so (Figure 1). (More precise information will become available when HM’s post-mortem findings are published.) It is, therefore, not unreasonable to suppose that there were inconsistencies between the intended and actual extent of tissue removal in these other eight cases.

There are additional concerns.

Scoville’s surgeries approached the medial temporal lobe from its front (i.e. via the temporal pole), an inevitable consequence of which was the removal of tissue in

lobe lesion: Findings from magnetic resonance imaging. Journal of Neuroscience, 17, 3964–3979.

Diana, R.A., Yonelinas, A.P. & Ranganath, C. (2007). Imaging recollection and familiarity in the medial temporal lobe: a three-component model.

Trends in Cognitive Science, 11, 379–386.

Lerner, V., Margolin, J. & Witztum, E. (2005). Vladamir Bekhterev: His life,

his work and the mystery of his death. History of Psychiatry, 16, 217–227.

Mishkin, M. (1978). Memory in monkeys severely impaired by combined but not by separate removal of amygdala and hippocampus. Nature, 273, 297–298.

Murray, E.A. & Mishkin, M. (1998). Object recognition and location memory in monkeys with excitotoxic lesions of

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front of the hippocampus. This tissue Subsequent comparisons using other included most of the amygdala and cases with more localised hippocampal pyriform cortex. The surgeries also damage (Spiers et al., 2001) have, in fact, produced variable amounts of tissue loss often supported the principal insights in other regions adjacent to the drawn from HM as these later cases also hippocampus (the ‘parahippocampal suffered clear losses of long-term memory region’, which includes the entorhinal and that contrasted with spared semantic perirhinal cortices – see Figure 1). There knowledge acquired prior to the amnesia. is no shortage of evidence that additional That said, HM’s amnesia appears damage to these adjacent areas can appreciably denser than that in cases exacerbate memory deficits (Aggleton & with more circumscribed hippocampal Brown, 1999; Diana et al., 2007). A closely related issue concerns the consequences of any white matter damage in HM as the surgical technique used by Scoville would have destroyed both white and grey matter. White matter damage is potentially very important as it might disrupt the functions of sites far removed from the hippocampus.

While MRI data (Corkin et al., 1997) indicate that Scoville probably spared the tract immediately lateral to the hippocampus (the temporal stem), he would have removed fibres linking the temporal pole with the frontal lobe.

Other tract damage in HM would almost certainly include those temporal stem fibres that leave the temporal lobe by passing directly through the Figure 1. HM’s surgery and the medial temporal lobe. The lateral and dorsal amygdala. upper level shows views of the underside of a brain (with Studies with monkeys have shown that cutting these fibres the cerebellum removed). The brain on the left indicates the intended extent of the medial temporal surgery in HM adds to cognitive impairments (region in brown). The dashed line shows approximately in tasks such as recognition how far back Scoville’s surgery actually went according to memory (Bachevalier et al., MRI evidence, leaving an area of potential sparing in the 1985). It can, therefore, be posterior hippocampus. The solid line shows the level of seen that HM did not suffer selective hippocampal loss and the coronal sections in the lower part of the figure. The coronal section on the left indicates the suspected area of that damage to adjacent areas tissue loss in HM, which clearly extends well into the is very likely to have parahippocampal region. contributed to his memory problems. As a consequence HM does not confirm that hippocampal damage. While there are several possible cell loss is either ‘necessary’ or ‘sufficient’ explanations for this difference, including for temporal lobe amnesia. the extent of hippocampal damage in

the amygdala and hippocampus.

Journal of Neuroscience, 18, 6568–6582.

Scoville, W.B. & Milner, B. (1957). Loss of recent memory after bilateral hippocampal lesions. Journal of Neurology, Neurosurgery & Psychiatry, 20, 11–21.

Spiers, H.J., Maguire, E.A. & Burgess, N. (2001). Hippocampal amnesia.

Neurocase 7, 357–382.

Squire, L.R., Wixted, J.T. & Clark, R.E. (2007). Recognition memory and the medial temporal lobe: A new perspective. Nature Reviews Neuroscience, 8, 872–883.

Tsivilis, D., Vann, S.D., Denby, C., et al.

(2008). A disproportionate role for the fornix and mammillary bodies in recall versus recognition memory.

Nature Neuroscience, 11, 834–842.

Vann, S.D. (2010) Re-evaluating the role of

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HM, it remains highly likely that the combination of additional white matter damage and the loss of tissue in structures adjacent to the hippocampus (e.g. the amygdala) added to his memory problems. Finally, his long-term use of anti-epileptic drugs may have caused cerebellar atrophy (Corkin, 2002).

Consequently there are numerous reasons why the amnesia in HM may have been particularly dense, and these reasons reflect more than just hippocampal cell loss.

Hierarchical models of medial temporal lobe function Consult almost any neuropsychological text and there will be a figure highlighting those medial temporal lobe connections most strongly linked to memory. This figure almost always comprises a series of connected boxes, with the hippocampus placed at the top (Figure 2, overleaf). Such figures inevitably convey a hierarchy with the hippocampus overseeing all other medial temporal lobe memory functions.

Although such depictions of medial temporal lobe anatomy were not created by research on HM, the persistent emphasis on hippocampal dysfunction in HM has surely reinforced and maintained this hierarchical view of medial temporal function. This perspective is all the more understandable when it is appreciated that the dominant model of medial temporal lobe memory systems has been one in which other temporal lobe structures are primarily critical for the ingress and egress of information to and from the medial temporal lobe, but it is the hippocampus that orchestrates this information (Squire et al., 2007; Wixted & Squire, 2011). This influential view of medial temporal lobe organisation now looks increasingly untenable.

the mammillary bodies in memory.

Neuropsychologia, 48, 2316–2327.

Vann, S.D. & Aggleton, J.P. (2004).The mammillary bodies – two memory systems in one? Nature Reviews Neuroscience, 5, 35–44.

Wixted, J.T. & Squire, L.R. (2011). The medial temporal lobe and the attributes of memory. Trends in Cognitive Science, 15, 210–217.

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The pivotal issue is the extent to impairments have become fused. which other temporal lobe structures The problem with conflating these have memory functions independent of impairments is beautifully highlighted by the hippocampus. Much of this debate a pair of experiments with monkeys that originally centred on the relative importance of the hippocampus and the parahippocampal region for recognition memory (the ability to detect when an event is repeated). One highly influential model supposes that the hippocampus is equally important for both recall and recognition, consistent with its position at the top of an anatomical hierarchy (Squire et al., 2007; Wixted & Squire, 2011). This model assumes that damage immediately beyond the hippocampus produces more of the same dysfunction, Figure 2. Potentially misleading hierarchical diagram reflecting this sharing of functions. This concept is very portraying the interconnections between the hippocampus, entorhinal cortex, perirhinal cortex, and pertinent because it directly parahippocampal cortex. The cortical regions at the implies that any extrabottom provide sensory information to the region. The hippocampal damage in HM thickness of the arrows reflects the strength of the disrupted processes that various connections. primarily depend on the hippocampus, and so do not materially affect his core status as sought to replicate the combined a hippocampal amnesic. amygdala plus hippocampal surgery in Other models have challenged HM. When the tissue was removed using this view. One class of model supposes Scoville’s surgical approach the monkeys that while the hippocampus is vital for were very severely impaired on object recognition memory based on the explicit recognition memory (Mishkin, 1978). recall of past experiences, adjacent When the same targets were removed by regions including the perirhinal cortex are injecting a chemical that kills neurons but independently important for recognition spares white matter, the animals were based on the feeling of familiarity unimpaired on object recognition (Aggleton & Brown, 1999; Diana et al., (Murray & Mishkin, 1998). This 2007). These ‘dual-process’ models contrasting pair of findings underlines the predict that amnesics with pathology significance of dysfunction in HM beyond restricted to the hippocampus will have the hippocampus, and its likely disproportionate deficits in recall, as contribution to recognition memory. recognition can be partially supported by familiarity. Such cases do exist (Brown et Looking beyond the al., 2010). In addition, there is much hippocampus evidence that the parahippocampal region One legacy of HM is that he reinforced has cognitive functions independent of the notion of different brain structures the hippocampus (Diana et al., 2007). with different roles in processing With regard to HM, he repeatedly information, so supporting a modular failed to recognise near-neighbours and approach to memory. A related legacy is friends who became acquainted with him that the hippocampus has become the after his surgery. HM was impaired on keystone for research into long-term both verbal and non-verbal recognition, memory. One consequence is that and for both yes-no and forced-choice research into neurological disorders tasks (Corkin, 2002). Consequently, there associated with memory loss, including seems little reason to suppose that HM dementias, remains dominated by showed a relative sparing of recognition hippocampal analyses, despite the memory. Unfortunately HM’s amnesia is potential significance of other areas so strongly identified as being within the temporal lobe. fundamentally hippocampal, and his Damage beyond the temporal lobe deficits for recall and recognition so can also cause anterograde amnesia. In widely described, that these two

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fact the first convincing evidence that damage to a specific brain site can cause amnesia concerns the mammillary bodies (the most posterior part of the hypothalamus), not the hippocampus (Vann & Aggleton, 2004). Remarkable clinical cases, such as BJ who had a snooker cue forced up his nose, damaging the base of this brain, have also specifically implicated the mammillary bodies (see Vann & Aggleton, 2004). Likewise, a largescale study of memory after tumors in the middle of the brain has highlighted the importance of the mammillary bodies (Tsivilis et al., 2008).

A number of other sites have been also implicated in amnesia (e.g. the anterior thalamic nuclei, parataenial thalamic nucleus, medial dorsal thalamic nucleus, retrosplenial cortex), and the fact that many of these structures are directly interconnected with the hippocampus has been given great significance. The assumption has typically been that these other regions are of secondary importance, and that the primary memory influences begin and end with the hippocampus. While such models are anatomically plausible, they have an inherent weakness if they fail to explain why the hippocampus might benefit from such a return circuit. The answer is surely that these other structures provide new information critical for temporal lobe function.

Indeed, recent research shows that it might be more insightful to see these other sites as primarily upstream, not downstream, from the hippocampus (Vann, 2010), i.e. reversing the traditional viewpoint. Such findings again emphasise the need to move to a more balanced view of memory substrates.

In many respects, HM remains the prototypical amnesic. (In fact, it could be argued that HM came to define what is now meant by the term amnesic.) There is little doubt that HM was unique, but that uniqueness is a double-edged sword given the multitude of special factors that may have influenced his memory performance. It feels almost sacrilegious to criticise the impact of HM, especially given the quality of the associated research. Nevertheless, the resultant narrow focus on the hippocampus for memory and memory disorders could well have excessively biased our thinking, with far-reaching, unwitting consequences.

I John P. Aggleton is in the School of Psychology, Cardiff University aggleton@cf.ac.uk

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Growing up with TV F

on their maturing relationship with the BBC’s Child of Our Time, which returns in 2007. substantially since then. Working on the production of the broadcasts involves planning the themes for forthcoming series, developing ideas for assessments and activities for the families to illustrate the themes, and participating in the final narrative and editing work for the programmes. At the same time, we are working on building content for the

Psychology Section conference, and are featured on the Coot website.

Concerns and issues Concerns are often aired about the impact on families of participating in television programmes. The families in the Coot project are always consulted about the content of the programmes, and are shown edited versions for their comments.

Sometimes, one or other family member does not want to be shown in a particular programme, and these wishes are always respected.

Negotiating informed consent for participation is something that is an ongoing process with the families, and there is also a conscious effort on the part of the production team to renew consent (or perhaps more accurately, assent) from the children as well, in terms that they can understand. The BBC has a comprehensive code for working with families, which is included in the guidelines that every producer is required to follow, and the Coot production team has developed substantial

website on Open2.net, commissioning essays and designing interactive materials, downloads and surveys for the site, and producing sets of activity cards, linked with the programme themes, for parents to order from the Open University. Print runs of 50,000 cards were fully taken up.

The public interest in Coot offerings is massive. Viewing figures for the series regularly exceed 4 or 5 million, with very high audience appreciation ratings. The traffic to the website immediately following the broadcasts is also very high and continues at high levels for some weeks. Enquiries to the Open University following on from the broadcasts, website and cards have been running at over 40,000 a year for the last two years. The OU considers that the cost of dealing with this volume is economically justified in terms of follow-through into entry level courses and other educational offerings.

For the last three years, we have added survey activities to the site, collecting data from children and adults on topics such as self-image, leisure preferences, expectations of parents and lifestyle choices. The website also shows summaries of these data as they build. For the 2006 series the survey was based on established research instruments and is gathering data on links among self-esteem, optimism, locus of control and moral action choices. Initial analyses from more than 16,000 respondents’ data were presented at the 2006 BPS Developmental

OUR TIME

‘The programme opens up alternative visions of parenting’

OF

An extended family Coot is a unique project, of which the prime-time broadcasts on BBC1 are only one facet (see figure opposite). Starting in 1999, 22 couples were filmed as they prepared for the births of their ‘millennium babies’. Since then, they have been followed and filmed year-on-year to build a rich record of the progress of the children and their families. The filming has covered life in the family homes, and the children’s and parents’ experiences in other settings, such as work, playgroups and school classes. There has also been a series of assessments and observations made of the parents and children, based around techniques used by psychologists. In addition, numerous experts have been brought in to comment on various topics and on the children’s and parents’ participation in ‘tests’.

The committed aim of the project is to follow this cohort of families until the children are 20 years old; the longestrunning project in the BBC’s history. The focus will continue to be on ‘what makes us what we are’.

The Open University joined the project as a co-production partner in 2002 and has been developing its involvement

JOHN OATES and DAVID MESSER

BBC CHILD

AMILY life, with all its ups and downs, is a constant presence on our television screens. There is a huge public appetite for guidance on parenting. In September 2006 a MORI poll with a representative sample of 3938 adults across Great Britain, for the National Family and Parenting Institute, showed that most parents with young children have watched at least one ‘parenting’ television programme and more than three quarters of these parents said that they had adopted a parenting technique and had found it helpful to them personally.

Developmental psychology has much to offer parents, and clearly television programmes are a potent way of reaching large numbers of parents, but this particular knowledge transfer is not an easy matter.

The messages that we might wish to transmit do not necessarily sit well with the priorities and narrative styles of broadcasters.

In this article, we reflect on our experience of working at the interface between academic research and public broadcasting, through our work on the BBC1 series Child of Our Time, affectionately known as ‘Coot’.

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additional guidance for the unique nature of the long-term involvement with these 22 families.

It is not sensible to draw direct parallels between television programme making and research ethics guidelines such as those of the British Psychological Society or the British Educational Research Association, since one of the common key principles in these research ethics codes – the preservation of anonymity – is clearly not feasible for broadcasts. However, the underlying principles of respect for individuals’ autonomy and well-being are most definitely applicable, and the procedures followed by the Coot production are explicitly designed to follow these ethics.

One aspect of this is taking pains not to encroach on the individuals’ privacy, and although Coot does show family life, the aim is not to be invasive in so doing.

Linked to this is the ethic of confidentiality.

Information collected from or given by the families, where they wish this to remain confidential, is closely protected by BBC protocols which conform with the requirements of the Data Protection Act. The showing of each year’s new Coot series is often the stimulus for local news stories, and the families do gain a sense of value from being featured in this way. At the same time, Coot quite consciously does not seek to make the families into ‘stars’.

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In a way, it is the ordinariness of the families that makes them special.

According to Rachel Coughlan, the series producer: â&#x20AC;&#x2DC;Although this is an on-going project, we donâ&#x20AC;&#x2122;t spend 12 months a year with the families. We pick out key events for filming. Some of the families have told me that although they regard their participation in the project as important, they also recognise that it is just a part of their life and for the rest of the time their lives tick over like any other family.â&#x20AC;&#x2122; Another more general concern involves the context and implicit messages of the programmes. We see one of the strengths of the Coot series as providing viewers with examples of childrenâ&#x20AC;&#x2122;s development and information about research findings, but without a strong message about what are the right and wrong things to do. The very diversity of the families in terms of their structure, environments and resources provide contrasts that raise questions about whether or not you as the viewer would respond in a similar way. Similarly, the way families cope with difficulties and the views of parents about â&#x20AC;&#x2DC;doing the bestâ&#x20AC;&#x2122; for their children can raise similar questions about oneâ&#x20AC;&#x2122;s own beliefs and assumptions.

Thus, a considerable strength of the programme is that it opens up alternative visions of parenting, and allows viewers to think more generally about this process with examples that are located outside of their normal environment and experience.

Viewers should be empowered by being able to think about issues themselves and to make their own decisions. Rather than

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experts providing a standard recipe for parenting, issues are often left open so that parents can think about the contrasts and come to their own view about what would be best to do.

There is an important issue here about the more general context in which psychologists wish their findings and expertise to be communicated. The media, more generally, are often interested in what is â&#x20AC;&#x2DC;bestâ&#x20AC;&#x2122; for children. However, it is often not recognised by those in the media that this question has to be unpicked not just in terms of psychological outcomes, but also in terms of value systems. In concrete terms this can involve thinking about what activities and behaviours are generally thought to be â&#x20AC;&#x2DC;bestâ&#x20AC;&#x2122;, but also taking into consideration that such activities and behaviours are not valued by all.

Furthermore, there are so many dimensions on which to carry out this discussion it almost becomes an impossible task.

Often psychologists are reluctant to go beyond their normal expertise to engage in this debate, a territory that is unfamiliar to many of us. However, it is one that increasingly needs to be addressed in relation to what some would see as desirable government support to parents and children and others see as the â&#x20AC;&#x2DC;nanny stateâ&#x20AC;&#x2122; taking away individual decision making. Our own view is that it can be useful to move away from these opposites to a consideration of not only the immediate effects of advice and intervention on childrenâ&#x20AC;&#x2122;s behaviours, but also the way in which parents feel that their 31

January 2007

www.thepsychologist.org.uk

Child of Our Time

DISCUSS AND DEBATE What key messages from psychological research would be of most value for parents?

How can parents be encouraged to evaluate ‘parenting’ messages critically?

Is there a value in giving more attention to children’s voices in debates around parenting?

What ‘blue sky’ ideas can we come up with to improve public engagement with psychological research through a variety of media?

Have your say on these or other issues this article raises. E-mail ‘Letters’ on psychologist@bps.org.uk or contribute to our forum via www.thepsychologist.org.uk.

OF

BBC CHILD

A two-way relationship Work on Coot provides a very useful model for the way that the needs of the media and psychologists can be met. It is important that programmes adopting this genre meet the agenda for public broadcasting by containing informative and relevant content. Consequently, programme makers like to include the latest ideas and theories, but there are risks for them in focusing on maverick opinions. Often programme makers will spend quite a bit of time talking to a range of researchers to build up a picture of current thinking about a topic. Even though these conversations may not directly feed into a programme, they provide an extremely valuable context.

Useful ideas come out of these conversations about how psychological theory and findings can challenge or support commonsense views about child development; for example the way that giving rewards for drawing reduces children’s liking of the activity in comparison to children who do not receive any rewards.

Naturally enough there are pressures to maintain a large audience to justify funding of the programme. As a result, a compromise has to be reached between informing and entertaining. Sometimes it can seem that academic psychologists reject this compromise by their emphasis on informing rather than entertaining. They can be caricatured as being primarily interested in the reactions of a limited number of fellow experts rather than those of the millions of viewers, in over-elevating their own interests, and a preference for long, complex and difficult-to-understand messages with many ‘ifs and buts’.

OUR TIME

self-esteem, control and autonomy have been affected by their experiences.

Happily this description is very much a caricature. Most psychologists recognise that entertainment helps with communicating information, and this often has formed a basis for productive relations.

We have been impressed by how keen the Coot producers are to discuss and explore modern ideas from developmental psychology theory and research, and to work with us on turning these into entertaining, as well as informative, viewing. An example from the 2006 series was translating issues about locus of control into a task where children had to carry a full bowl of water without spilling it, and asking children whether the inevitable messy spill was due to the difficulty of the task or their own inability.

This was probably more interesting and memorable for many viewers than seeing a child answer a set of psychometric questions. Rachel Coughlan comments: ‘Quite often the tests that we use for the purposes of television have to be made more visual whilst retaining their validity and we have found that our psychology academics have been open and willing in helping us achieve this. They also guide us in terms of the themes that are appropriate for the age of the children, and evaluate some of the assessments in order to make a particular point clear to our audience. The synergy between the television and the website works extremely well for our audience, who are able to follow up themes in the programme in greater depth if they so wish. This is an area we are keen to expand in the future.’

Towards the future Psychologists are becoming much more aware of the increasing pressures to inform a wider audience. There is an obligation to communicate publicly funded research findings, and when applying for research funding there is increasingly a box that has to be filled about ‘dissemination of research’. There also is a growing awareness that public interest in psychological research can feed into positive views about research funding, and can even encourage student uptake of higher and further education.

Thus, there is a measure of interdependence. Programme makers need upto-date expert advice to provide credibility for a programme as well as helping to meet with public agenda and well-being issues.

Researchers can benefit, albeit indirectly, from public interest and understanding.

There is a strong wish amongst those of us in the Open University and the BBC who are involved with Child of Our Time to strengthen the synergies between research and the project. The British Psychological Society has recently given public engagement funding for additional content production for the Coot website, to provide more extended and in-depth coverage of developmental psychology topics. Also, the ESRC has commissioned a scoping study which is exploring how links can be built between the Child of Our Time resources and research activities, such as the Millennium Cohort Study and other large surveys. This study is being carried out by a team of researchers including ourselves. We would be very interested in hearing from anyone who would like to contribute to this ongoing work.

■ John Oates and David Messer are in the Centre for Childhood, Development and Learning at the Open University.

E-mail: fels-cootscope@open.ac.uk.

WEBLINKS Open University Child of Our Time site: www.open2.net/childofourtime/2006/index.html BBC site: www.bbc.co.uk/parenting/ tv_and_radio/child_of_our_time BBC JAM child development materials, using footage from Coot to provide curriculum enrichment for GCSE Psychology: https://jam.bbc.co.uk

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January 2007

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2014 CPD Workshops Professional development opportunities from your learned Society Career pathways in clinical forensic psychology (DCP)

10 February

The neuropsychological management of Multiple Sclerosis (DoN) (Liverpool)

13 February

Strategies for improved decision-making (Cognitive Section)

19 February

Using therapeutic skills to engage individuals with physical and long-term conditions to manage their health (DHP)

21 February

An introduction to sleep: Psychobehavioural assessment and treatment strategies for people with insomnia (DCP)

24 February

Refresher course on Repertory Grids (DOP)

27 February

Overcoming OCD and its complications: The devil is in the detail (DCP)

28 February

Developing effective, efficient, equitable, acceptable and accessible services for common mental health problems in the age of austerity (DCP / Community Section)

4 March

Get productive wheel: Using systemic thinking for supporting best performance, well-being and mental health (SGCP)

5 March

Supervision skills training: Workshop 2 – Enhancing supervision skills

12 March

The Behaviour Change Wheel Guide to intervention development, evaluation and evidence synthesis (DHP) (Liverpool)

13 March

Cognitive analytic therapy in a forensic setting (DFP / DCP)

14 March

Cognitive assessments with children and young people in CAMHS and other non-specialist settings: Update your skills (DCP)

20 March

Expert witness: Use of psychometric assessments for court (Level 4)

21 March

What does commissioning mean for Clinical psychology? (DCP) (Brighton)

21 March

The practice of educational psychology in an increasingly diverse society (DCP)

24 March

Developing evidence-based approaches to practice in organisational psychology (DOP)

28 March

Advanced Interpretative Phenomenological Analysis (IPA) (DHP / DFP / QMiP)

31 March

Supervision skills training: Workshop 4 – Ongoing development – Supervision of supervision

2 April

Researching your psychology teaching practice: an action research approach (DARTP)

4 April

What's the story? Using metaphor and stories in therapy, counselling and coaching (DCP / SGCP)

9 April

Working sucessfully in private practice

10 April

Exploring terrorism and extremist behaviour (DCP / DFP)

17 April

Developing mental strength: Applying positive psychology in sport (DSEP)

25 April

Supervision skills training: Workshop 1 – Essentials of supervision

25 April

Understanding childhood feeding disorders – Causes, diagnosis and interventions (DCP / DECP / Developmental)

28 April

Planning and implementing psychological treatment for eating disorders (DCoP / DHP / PoWS / Psychotherapy)

29 April

What do meditation and mindfulness have to offer to the 21st Century practitioner? (Transpersonal)

2 May

For more information on these CPD events and many more visit www.bps.org.uk/findcpd.

Follow us on Twitter: @BPSLearning #BPScpd

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‘Them and us’ in mental health services Christina Richards looks behind the dichotomy and calls for change

here is a dichotomy in mental health services: ‘them and us’, or what Pilgrim (2005, p.123) refers to as ‘two groups of humanity’. This is the process in which some clinicians, psychologists and allied professionals treat the recipients of their services as being in some ineffable, but very real way, ‘other’.

Buber (1958) refers to this as ‘I-It relating’ in which we only see part of the other person and limit our view of them to that, rather than the ‘I-Thou relating’ that we do when we recognise that the person in front of us is as fully human as we are ourselves. I will argue that within medicine, psychology, social care and beyond this may lead to iatrogenic ‘illnesses’ which are the result of ‘care’ that necessarily positions the recipient as ‘other’ (Johnstone, 2000; Laurance, 2003).

We can see this even in third sector organisations’ conceptions of mental distress. For example, the current ‘Time to Change’ movement – a project with a budget of £18 million conducted by an affiliation of Mental Health Media, Mind and Rethink, and evaluated by the Institute of Psychiatry – has the stated mission: ‘To inspire people to work together to end the discrimination surrounding mental health’. This might seem a laudable aim. However, they go on to repeat the commonly used assertion that ‘one in four adults experience mental health problems in any one year’ (tinyurl.com/mqhek7). Presumably the intention is to suggest that one in four is quite a high number of people and so

references

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Buber, M. (1958). I and Thou (2nd edn, Trans. R.G.Smith). London: Continuum.

Byrne, P. (2000). Stigma of mental illness and ways of diminishing it. Advances in Psychiatric Treatment, 6, 65–72.

Deegan, P.E. & Drake, R.E. (2006). Shared decision making and medication management in the recovery process.

Psychiatric Services, 57, 1636–1639.

Fiske, S.T. & Taylor, S.E. (1991). Social

people with mental health issues should not be discriminated against because they are just like everyone else.

However, there are problems with the ‘one in four’ estimate. Although seldom referenced explicitly, it seems that it pertains to a 2000 Office of National Statistics study (Singleton et al., 2001) or to the World Health Organization’s (WHO) World Health Report 2001 (tinyurl.com/msqmy7). The WHO report refers to one in four families rather than people. A reading of the Office of National Statistics study demonstrates that the figures do not allow such a simple breakdown as ‘one in four’ as a cumulative figure, because the study uses a variety of different timescales, evaluation scales, and different (not mutually exclusive) categories of mental distress.

Aside from the problems with the figure itself, I suggest that the reading of the figure may be rather different from the intent of the bodies who so readily use it.

That is, that if 25 per cent of people are in the group who have a mental health problem then 75 per cent of people – the substantial majority in fact – are not. It suggests that the ‘one in four’ are different from ‘most people’. This is concerning because as we know, difference (especially minority difference) is a cause of discrimination (Infinito, 2003; Sherif, 1956). Thus people with mental health problems are being situated as ‘them’ even by the very organisations set up for ‘their’ assistance.

There are clearly societal factors, then,

cognition (2nd edn). New York: McGraw-Hill.

Fowler, J.H. & Christakis, N.A. (2008).

Dynamic spread of happiness in a large social network. British Medical Journal, 337, a2338.

Glover, H. (2005). Recovery based service delivery. Australian e-Journal for the Advancement of Mental Health, 4, 8–11.

Hatfield, E., Cacioppo, J.T. & Rapson, R.L. (1993). Emotional contagion. Current

in the dichotomisation of mental health service providers and their patients, but there are also intrapersonal factors at work. Clinical psychologist Lucy Johnstone (2000) explains this by stating that ‘[some] staff need patients to continue to be patients for their own personal reasons’ (p.206). She argues that this is because of (broadly) a desire for job security (as effective clinicians makes themselves redundant) and adherence to an enveloping system in which power is granted to those who comply; meaning those with the most power are the most invested in the system. Johnstone goes on to report the great anti-psychiatrist Loren Mosher’s suggestions for the four deadly sins (in the eyes of upholders of the orthodoxy) of critical psychiatry (and one would imagine applied psychology): demedicalising madness, de-hospitalising people, de-psychopharmacologising and de-professionalising. This might be summed up in Johnstone’s later statement that ‘psychiatry has not been well served by the philosophy of “studying people as if they were things”’ (p.252). The august, albeit fictional, ‘headologist’ Esme Weatherwax (in Terry Pratchett’s Discworld novels) agrees, stating: ‘…sin, [young man], is when you treat people as things. Including yourself. That’s what sin is.’

This ‘treating people as things’ may also be explained by the cognitive dissonance set up in some clinicians when they come across a patient who, due to contextual factors, such as an advanced degree, substantial income, etc., upset the clinician’s conceptions of what a mental health patient should be like (for a brief discussion of clinician stereotyping see Byrne, 2000). The clinician may attempt to resolve the conflict between the apparent facts and their conception of the patient with one of three methods: classing the patient as an exception to the rule; suggesting that the patient is not really a patient; or changing their mind about the nature of psychiatric patients.

This last possibility is seldom seen, and a reason why may be inferred from a

Directions in Psychological Science, 2, 96–99.

Infinito, J. (2003). Jane Elliot meets Foucault: The formation of ethical identities in the classroom. Journal of Moral Education, 32(1), 67–76.

Johnstone, L. (2000). Users and abusers of psychiatry (2nd edn). London: Routledge.

Laurance, J. (2003). Pure madness: How fear drives the mental health system.

London: Routledge.

Menzies, I.E.P. (1960). A case study in the functioning of social systems as a defence against anxiety. Human Relations, 13(2), 95–121.

Oades, L.G., Crowe, T.P. & Nguyen, M. (2009). Leadership coaching transforming mental health systems from the inside out. International Coaching Psychology Review, 4, 25–36.

Pilgrim, M. (2005). Key concepts in mental

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study by Fowler and Christakis (2008).

This suggested that happiness spreads dynamically within a social network and is mediated primarily by social, rather than actual, distance between people.

If social distance mediates happiness then it might be reasonable to assume that it mediates unhappiness too.

However, Fowler and Christakis found no evidence for this, reporting instead that additional happy social contacts (to a maximum of three) increased

This accords with the Fowler and Christakis (2008) finding (albeit regarding co-workers rather than patients), that ‘[there was] no effect of the happiness of co workers…suggesting that the social context and distance might moderate the flow of happiness from one person to another’ (p.7).

Even if clinicians could be motivated to change due to an understanding that social prophylaxis through distance is unnecessary, it is possible that some

the ‘Richards effect’, for narcissistic reasons – crosses domains. Clinically, I see it in patients in their forties and older who seem stuck by the notion of what they could have achieved, if only they had beat their depression or changed gender role earlier in life. To do so now would suggest to them that it is possible, and so by inference would have been in the past; the very idea of which is intolerable. I also saw the effect in my previous incarnation as a climbing instructor, when people would be resistant to learn how to safely hold the ropes for other climbers in the “some mental ‘modern way’ – imagine the idea of health professionals having been a dangerous climbing may find the partner despite your best intentions. prospect of changing The examples are endless.

Perhaps, rather than maintaining their practice to be these in- and outgroups of staff and more friendly to patients with all the associated costs patients too attendant to that process (cf. Fiske threatening to their & Taylor, 1991) and to the patient, psychic integrity to we should look to the literature that countenance” has shown the benefits of a genuinely collaborative effort (e.g.

Ross & McKay, 1979) and to the nascent recovery approach (Deegan I Christina Richards is Senior Specialist Psychology Associate, West London Mental Health NHS Trust & Drake 2006; Glover, 2005; Oades christina.richards@wlmht.nhs.uk et al., 2009). In these approaches there is a common effort towards the actualisation of the resources of the happiness, but additional unhappy social mental health professionals who have person who is suffering, and a recognition contacts had no effect. They do suggest, been practising for many years may find of the skills and experience that both this however, that ‘we might yet find that the the prospect of changing their practice person and the professionals bring to the “three degrees of influence” rule applies to be more friendly to patients too endeavour. to depression, anxiety, loneliness…’ (p.8), threatening to their psychic integrity to Perhaps, despite the distress it may a comment that is echoed the work of countenance. Menzies (1960), in a cause those of the ‘us’ who work in Hatfield et al. (1993). hospital-based study within the mental health, we could combat stigma This, then, may be why some mental psychodynamic tradition, suggested that and work more effectively and humanely health workers have grave concerns about this is an internalised social systemic by realising that we are all just one big behaving in a friendly manner (not defence against anxiety predicated on ‘group of humanity’, one big ‘us’. We ‘become friends’, which is a different systemically induced underdeveloped should understand that there is a ethical issue) with the people that use (or regressed) psychic defences. continuum of mental health that we all their services. It may be an implicit While there appears to be little hard share, rather than being on one side or (questionable) concern, and reaction evidence in the literature pertaining to another of a ‘one in four divide’, and that to, the possibility of socio-proximally this idea, I offer my own previous we all need to rub along as best we can. mediated affective contagion: mental experience of working with contemporary It can be done: not all clinicians create health workers are trying to keep clinicians as a start and a call for further an ‘us and them’ dichotomy with patients. themselves healthy through creating an research. The reasoning concerning My current colleagues, perhaps because ingroup of ‘us’ and an outgroup of ‘them’. clinician reticence to change runs thus: the unusual field we work in draws ‘I have been doing things this way for exceptional workers, act as exemplars of years and will continue to do so as this how this situation may be resolved in a way must be right’ (because if I have been way that is both professional and doing it wrong for all these years look at sensitive. But it requires us to accept the health. London: Sage. all the pain I’ve caused/ time I’ve wasted/ risks attendant to the professions, Ross, R.R. & McKay, H.B. (1979). Self good I could have done). It boils down including cognitive dissonance, the mutilation. Lexington, MA: Lexington to: ‘I can’t act in the future, because that possibility of emotional contagion and Books. proves I could have done so in the past’, societal pressures. As clinicians, we need Sherif, M. (1956). Experiments in group although the resistance to change has to work to ameliorate any adverse effects, conflict. Scientific American, 195, 54–58. historical roots that are often not in not through the alienation of patients, but Singleton, N., Bumpstead, R., O’Brien, M. et al. (Office for National Statistics) (2001). conscious awareness and the inference through other endeavours such as Psychiatric morbidity among adults living that it ‘proves that it could have been ensuring we take enough physical in private households. London: The done in the past’ may be faulty. exercise, cutting down smoking, eating Stationery Office.

Interestingly this effect – let’s call it well, meditating and the like.

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